胎膜早破孕妇阴道微生态和胎盘分离菌及耐药性分析

Analysis of vaginal microecology and placental isolates and drug resistance in pregnant women with premature rupture of membranes

目的 比较胎膜早破和正常破裂孕妇孕晚期(孕35~37周)阴道微生态、胎盘拭子细菌分布和耐药性情况,为临床预防和治疗提供病原学依据。方法 收集甘肃省妇幼保健院产科2020年1月1日至2022年6月30日胎盘拭子培养结果,将培养阳性的孕妇分成胎膜早破组和正常破裂组,比较两组基本临床特征及孕晚期阴道微生态、胎盘分离菌和药敏结果。结果 两组孕周、年龄、细菌性阴道病和正常微生态情况差异有统计学意义(P<0.05);多因素Logistic回归分析显示孕周(β=-0.711,OR=0.491)和正常微生态(β=-1.412,OR=4.103)与胎膜早破发生呈负相关,年龄(β=0.076,OR=1.079)呈正相关,细菌性阴道病的差异无统计学意义(P>0.05)。两组胎盘主要分离菌为革兰阴性杆菌,差异无统计学意义(P>0.05),以大肠埃希菌为主,检出率差异有统计学意义(P<0.05),胎膜早破组产超广谱β-内酰胺酶比例较高,对氨苄西林、头孢类耐药性高,差异有统计学意义(P<0.05);其次是革兰阳性球菌(粪肠球菌和无乳链球菌为主),差异无统计学意义(P>0.05)。无乳链球菌对青霉素类、糖肽类等敏感,对喹诺酮类耐药率较高;粪肠球菌对青霉素类、糖肽类、恶唑烷酮类等敏感,对红霉素和克林霉素的耐药性较高。结论 胎膜早破组年龄偏大且孕周小,孕晚期易发生阴道微生态异常,其胎盘拭子大肠埃希菌检出率、对青霉素和头孢类抗生素耐药性较高。

Objective To compare the vaginal microecology,placental swab bacterial distribution and drug resistance in pregnant women with premature rupture of membranes and normal rupture of mem-branes in late pregnancy(35-37 weeks of pregnancy),to provide etiological basis for clinical prevention and treatment.Methods The results of placental swab cultures at the Obstetrics Department of Gansu Provincial Maternity and Childcare Hospital from January 1,2020 to June 30,2022 were collected.Pregnant women with positive cultures were divided into two groups:those with premature rupture of membranes and those with normal rupture of membranes.The study analyzed the basic clinical characteristics,vaginal microecology in late pregnancy,and the distribution and drug sensitivity results of the main isolates in placental swab cul-tures of the two groups.Results There were significant differences in gestational age,bacterial vaginosis and normal microecology between the two groups(P<0.05).Multivariate logistic regression analysis showed that pregnancy week(b=-0.711,OR=0.491)and normal microecology(b=-1.412,OR=4.103)were negatively correlated with the occurrence of premature rupture of fetal membranes,while age(b=0.076,OR=1.079)was positively correlated.There was no significant difference in bacterial vaginosis(P>0.05).The main bacteria isolated from the placenta between the two groups were gram-negative bacteria,with no significant difference(P>0.05),mainly Escherichia coli.The difference in detection rate was statistically significant(P<0.05).The proportion of ultra-broad spectrumβ-lactamase production in the premature rupture group was higher,and the resistance to ampicillin and cephalosporin was also higher,with a statistically significant difference(P<0.05).The second most common bacteria were gram-positive cocci(E.faecalis and Streptococcus agalactis),with no statistically significant difference(P>0.05).Streptococcus agalactis is sensitive to penicillins and glycopep-tides,with a high resistance rate to quinolones.Enterococcus faecalis was sensitive to penicillins,glycopep-tides,and oxazolidinones,but had high resistance to erythromycin and clindamycin.Conclusion The prema-ture rupture of membranes group includes both older and younger individuals,with vaginal microecological ab-normalities more likely to occur in late pregnancy.The detection rate of Escherichia coli in placenta swabs as well as resistance to penicillin and cephalosporin antibiotics,is higher in this group.