46例医院和社区获得性血流感染孕产妇的临床特征与病原菌分布分析

Clinical Characteristics and Pathogen Distribution Analysis of 46 Cases of Hospital and Community Acquired Bloodstream Infections of Pregnant and Postpartum Women

目的回顾性分析比较孕产妇医院和社区获得性血流感染的临床特征、母儿结局以及病原菌分布的差异,为临床诊治提供科学的参考依据。方法收集本院2013年1月—2023年4月血流感染孕产妇病例的临床资料、血培养分离病原菌分布及药敏试验结果。结果医院获得性血流感染27例,社区获得性血流感染19例,妊娠期贫血占56.5%(26/46)、妊娠期糖尿病以及胎膜早破各占41.3%(19/46),胎膜早破发生率、催引产干预(70.4%)以及中转剖宫产率(66.7%)、白细胞计数及C反应蛋白数值医院感染组均明显高于社区感染组,早产率则社区感染组(47.4%)高于医院感染组(18.5%),差异有统计学意义(P<0.05)。两组病原菌株均以大肠埃希菌(28株)为主,其中有19株(70.4%)为超广谱β内酰胺酶(ESBL)阳性,对阿米卡星、厄他培南、美洛培南、亚胺培南、头孢西丁、头孢哌酮/舒巴坦敏感率为100.0%,对氨苄西林、头孢唑啉、头孢呋辛等耐药率均超过60.0%。结论孕产妇血流感染严重影响妊娠结局,严格控制中转剖宫产可降低医院获得性血流感染风险。孕产妇血流感染以大肠埃希菌感染率最高,对发热的孕产妇需尽早行血培养,针对性选择敏感抗生素,可改善母儿结局,降低母儿死亡率。

Objective To review,analyze and compare clinical characteristics,maternal and fetal outcomes,and pathogen distribution difference between hospital and community acquired bloodstream infections of pregnant and postpartum women,to provide scientific reference for clinical diagnosis and treatment.Methods The paper collected clinical data,distribution of pathogenic bacteria isolated from blood culture,and drug sensitivity test results of pregnant and postpartum cases with blood influenza infection in our hospital from January 2013 to April 2023.Results There were 27 cases of hospital acquired bloodstream infection and 19 cases of community acquired bloodstream infection.Anemia in pregnancy accounted for 56.5%(26/46),diabetes in pregnancy and premature rupture of membranes accounted for 41.3%(19/46)respectively.Incidence of premature rupture of membranes,induced abortion intervention(70.4%),and conversion rate to cesarean section(66.7%),white blood cell count and C-reactive protein values in hospital infection group were significantly higher than community infection group,premature birth rate in community infection group(47.4%)was higher than hospital infection group(18.5%),with statistically significant difference(P<0.05).Pathogenic strains were mainly Escherichia coli(28 strains)in two groups,of which 19 strains(70.4%)were broad-spectrumβ(ESBL)positive,with sensitivity rate of 100%to amikacin,ertapenem,meropenem,imipenem,cefoxitin,cefoperazone/sulbactam,and resistance rate of over 60%to ampicillin,cefazolin,cefuroxime and etc.Conclusion Maternal bloodstream infections affect pregnancy outcomes seriously,and strict control of transitioning to cesarean section can reduce risk of hospital acquired bloodstream infections.Escherichia coli has the highest infection rate among pregnant and postpartum bloodstream infections.It is necessary to carry on blood culture for pregnant and postpartum women with fever as early as possible,targeted selection of sensitive antibiotics can improve maternal and fetal outcomes and reduce maternal and fetal mortality.