妊娠期糖尿病产妇产后感染病原菌耐药性分析及其对外周血单核细胞TLR4炎症通路的影响

Analysis of drug resistance of pathogens of puerperal infection in pregnant women with diabetes and its influence on toll like receptor 4 inflammatory pathway of peripheral blood mononuclear cells

目的探究妊娠期糖尿病(GDM)产妇产后感染病原菌的耐药性,分析产后感染对外周血单核细胞Toll样受体4(TLR4)炎症通路表达的影响。方法回顾性选取2020年1月至2022年10月在中国人民解放军联勤保障部队第九〇三医院定期产检、分娩的GDM产妇120例,对产妇的产后感染情况、感染病原菌的病原学特点及耐药性进行分析;根据产后感染情况将产妇分为感染组与未感染组,logistic回归分析法分析影响产后感染的相关因素,比较两组外周血单核细胞TLR4蛋白及mRNA表达水平。结果120例GDM产妇中产后感染21例(17.50%),感染类型包括:切口感染8例(38.10%),宫腔感染6例(28.57%),泌尿系统感染4例(19.05%),血液感染3例(14.28%);共检出43株感染病原菌,其中革兰阴性菌26株(60.46%),革兰阳性菌14株(32.56%),真菌3株(6.98%)。主要革兰阴性菌中,大肠埃希菌对头孢他啶、四环素耐药率最高,未对美罗培南产生耐药;铜绿假单胞菌对头孢他啶、庆大霉素耐药率最高。主要革兰阳性菌中,金黄色葡萄球菌对青霉素G、头孢他啶耐药率最高,未对万古霉素产生耐药;粪肠球菌对克林霉素耐药率最高。多因素logistic回归分析结果显示,产后出血、胎膜早破和产前血糖控制不佳是影响GDM产妇产后感染的独立危险因素(均P<0.05)。感染组的TLR4蛋白表达率、TLR4 mRNA相对表达量及TNF-α、IL-1、IL-10水平均明显高于未感染组(均P<0.05)。结论GDM产妇产后感染的病原菌分布和耐药性具有一定特征性,产后出血、胎膜早破和产前血糖控制不佳是影响GDM产妇产后感染的独立危险因素;外周血单核细胞TLR4炎症通路可能参与了GDM产妇产后感染的发生发展。

Objective To explore the drug resistance of pathogens in puerperal infection of pregnant women with diabetes mellitus(GDM),and analyze the influence of puerperal infection on the expression of toll like receptor 4(TLR4)inflammatory pathway in peripheral blood monocytes.Methods A retrospective selection was conducted on 120 GDM postpartum women who underwent regular prenatal check ups and delivery at the 903th Hospital of the PLA(People′s Liberation Army)Joint Logistic Support Force from January 2020 to October 2022.The postpartum infection status,pathogenic characteristics of the infected pathogens,and drug resistance of the mothers were analyzed;According to the postpartum infection situation,the parturients were divided into an infected group and an uninfected group.Logistic regression analysis was used to analyze the relevant factors affecting postpartum infection,and the TLR4 protein and mRNA expression levels of peripheral blood mononuclear cells in the two groups were compared.Results Among 120 GDM pregnant women,21 cases(17.50%)developed post infection,including 8 cases(38.10%)of incision infection,6 cases(28.57%)of uterine cavity infection,4 cases(19.05%)of urinary system infection,and 3 cases(14.28%)of blood infection;A total of 43 pathogenic bacteria were detected,including 26 Gram negative bacteria(60.46%),14 Gram positive bacteria(32.56%),and 3 fungi(6.98%).Among the main Gram negative bacteria,escherichia coli had the highest resistance rate to ceftazidime and tetracycline,and had not developed resistance to meropenem;Pseudomonas aeruginosa had the highest resistance rate to ceftazidime and gentamicin.Among the main Gram positive bacteria,staphylococcus aureus had the highest resistance rate to penicillin G and ceftazidime,and had not developed resistance to vancomycin;Enterococcus faecalis had the highest resistance rate to clindamycin.The results of multivariate logistic regression analysis showed that postpartum hemorrhage,premature rupture of membranes,and poor control of prenatal blood sugar were independent risk factors for postpartum infection in GDM mothers(all P<0.05).The expression rate of TLR4 protein,relative expression level of TLR4 mRNA,and levels of tumor necrosis factor-α(TNF-α),interleukin(IL)-1,and IL-10 in the infected group were significantly higher than those in the non infected group(all P<0.05).Conclusions The distribution and drug resistance of pathogenic bacteria in postpartum infections of GDM mothers have certain characteristics.Postpartum hemorrhage,premature rupture of membranes,and poor control of prenatal blood sugar are independent risk factors affecting postpartum infections in GDM mothers;The TLR4 inflammatory pathway in peripheral blood mononuclear cells may be involved in the occurrence and development of postpartum infection in GDM mothers.