妇科门诊女性生殖道分泌物病原菌分离鉴定及耐药情况分析

Identification of Pathogenic Bacteria Isolated from Female Genital Tract Secretions and Analysis of Drug Resistance in Gynecological Outpatient Clinics

目的:分析妇科门诊女性生殖道分泌物病原菌分离鉴定及耐药情况。方法:选取2018年3月—2020年11月夏邑县人民医院妇科门诊收治的114例女性患者作为研究对象,均采集生殖道分泌物样本,行病原菌培养和药敏试验,进行病原菌分离鉴定及耐药情况研究。结果:114份妇科门诊女性生殖道分泌物标本中检出病原菌阳性样本50份,阳性率为43.86%,共检出菌株121株,其中两种以上混合感染检出26份。文化程度低者检出率较文化程度高者高,有性生活者检出率较无性生活者高,差异有统计学意义(χ^(2)=6.195、4.154,P<0.05);检出的121株病原菌中;革兰阴性菌31株,占比25.62%,以大肠埃希菌(13.22%)为主;革兰阳性菌42株,占比34.71%,以粪肠球菌(12.40%)为主;真菌48株,占比39.67%,以白色假丝酵母菌(27.27%)为主。大肠埃希菌对氨苄西林耐药率较高,对阿米卡星、头孢西丁耐药性较低,对美罗培南、亚胺培南、氟康唑无耐药性;粪肠球菌对红霉素、复方新诺明、四环素耐药性较高,对万古霉素、氨苄西林耐药性较低,对替考拉宁无耐药性;白色假丝酵母菌对伊曲康唑、硝酸咪康唑耐药性较高,对氟胞嘧啶、两性霉素B耐药性较低。结论:妇科门诊女性患者生殖道分泌物病原菌检出率较高,多为真菌感染,其次为革兰阳性菌、革兰阴性菌,生殖道感染病原菌种类较多,对各个抗菌药物耐药性存在不同,临床应在分析耐药性基础上进行治疗,重视女性生殖分泌物感染筛查,参照药敏试验结果,科学使用抗菌药,提高治疗效果。

Objective:To analyze the isolation and identification of pathogenic bacteria and drug resistance in female genital tract secretions from gynecological outpatient clinics.Methods:114 female patients in the hospital from March 2018 to November 2020 were selected,and all of them collected genital tract secretion samples,performed pathogenic bacteria culture and drug sensi⁃tivity test for pathogenic bacteria isolation and identification and drug resistance study.Results:Among the 114 specimens of fe⁃male genital tract secretions from gynecological clinics,50 positive samples of pathogenic bacteria were detected,with a positive rate of 43.86%and a total of 121 strains detected,of which 26 mixed infections of two or more were detected.The detection rate was higher in those with low literacy than in those with high literacy,and the detection rate was higher in those with sexual inter⁃course than in those without sexual intercourse,with statistically significant differences(χ^(2)=6.195,4.154,P<0.05).Among the 121 pathogenic strains detected,31 strains of Gram-negative bacteria,accounting for 25.62%,were mainly Escherichia coli(13.22%),42 strains of Gram-positive bacteria,accounting for 34.71%,were mainly Enterococcus faecalis(12.40%),48 strains of fungi,ac⁃counting for 39.67%,were mainly Pseudomonas albicans(27.27%).Escherichia coli had high resistance to ampicillin,low resis⁃tance to amikacin and cefoxitin,and no resistance to meropenem,imipenem and fluconazole.Enterococcus faecalis had high resis⁃tance to erythromycin,cotrimoxazole and tetracycline,low resistance to vancomycin and ampicillin,and no resistance to teico⁃planin.Pseudomonas albicans has high resistance to itraconazole and miconazole nitrate,and low resistance to flucytosine and am⁃photericin B.Conclusion:The detection rate of pathogenic bacteria in the genital tract secretions of female patients in gynecologi⁃cal clinics is high,mostly fungal infections,followed by gram-positive and gram-negative bacteria,and there are more types of pathogenic bacteria in the genital tract infections,with different resistance to each antibacterial drug.Clinical treatment should be based on the analysis of drug resistance,attaching importance to the screening of female genital secretion infection,referring to the results of drug sensitivity tests,and scientifically using antibacterial drugs to improve the therapeutic effect.