肉芽肿性小叶性乳腺炎患者病灶区脓液病原菌的构成比及耐药性分析

composition ratio and drug resistance rate of pathogenic bacteria in pus of focal area of granulomatous lobular mastitis

目的分析肉芽肿性小叶性乳腺炎患者病灶区脓液病原菌的构成比及耐药性情况。方法回顾性分析,选取2021年8月至2022年8月铜川市人民医院收治的肉芽肿性小叶性乳腺炎患者200例作为研究对象,年龄(32.15±3.85)岁,病程(29.56±6.12)d。分别于入院后第2天收集所有患者病灶区脓液,进行培养分离鉴定,分析病灶区脓液病原菌构成分布情况,对革兰阳性菌行药敏试验,分析病原菌对药物耐药性情况。结果肉芽肿性小叶性乳腺炎患者病灶区脓液检测革兰阳性菌81.00%(162/200)、革兰阴性菌17.50%(35/200)、白色念珠菌1.50%(3/200),其中革兰阳性菌中棒状杆菌属占比为68.50%(137/200),革兰阴性菌中不动杆菌占比为8.50%(17/200)。137例脓液棒状杆菌属中,微小棒状杆菌、水生棒状杆菌、G群棒状杆菌、A群棒状杆菌占比分别为30.66%(42/137)、15.33%(21/137)、13.87%(19/137)、9.49%(13/137)。棒状杆菌属中,苯唑西林、克林霉素、红霉素耐药率分别为74.74%(71/95)、85.26%(81/95)、81.05%(77/95),万古霉素、利奈唑胺、利福平、庆大霉素耐药率均为0;其他革兰阳性菌中,苯唑西林、克林霉素耐药率分别为60.00%(15/25)、72.00%(18/25),万古霉素、利奈唑胺耐药率均为0。结论革兰阳性菌是肉芽肿性小叶性乳腺炎病灶区脓液中主要病原菌,其中棒状杆菌属占比较高,革兰阳性菌对万古霉素、利奈唑胺、利福平、庆大霉素耐药率极低,可选择以上药物进行治疗。

Objective To investigate the composition ratio and drug resistance rate of pathogenic bacteria in the pus of the focal area of granulomatous lobular mastitis.Methods Two hundred patients with granulomatous lobular mastitis admitted to Tongchuan People's Hospital from August 2021 to August 2022 were selected as the study objects;they were(32.15±3.85)years old;their disease course was(29.56±6.12)days.The pus from the lesion area of all the patients was collected on the second day after admission for culture,isolation,and identification.The distribution of pathogenic bacteria in the pus was analyzed.Drug sensitivity tests were conducted on the Gram positive bacteria.The drug resistance of the pathogenic bacteria was analyzed.Results Among the 200 patients,Gram positive bacteria was detected in 162 ones(81.00%),Gram negative bacteria in 35(17.50%),and Candida albicans in 3(1.50%).Among the Gram positive bacteria,Corynebacterium accounted for 68.50%(137/200).Among the Gram negative bacteria,Acinetobacter accounted for 8.50%(17/200).Among the 137 cases of Corynebacterium pyogenes,Microbacterium,Aquatic Corynebacterium,Group G Corynebacterium,and Group A Corynebacterium accounted for 30.66%(42/137),15.33%(21/137),13.87%(19/137),and 9.49%(13/137),respectively.The resistance rates of genus Corynebacterium against oxacillin,clindamycin,and erythromycin were 74.74%(71/95),85.26%(81/95),and 81.05%(77/95),respectively;the resistance rates against vancomycin,linezolid,rifampicin,and gentamicin were 0.The resistance rates of Gram positive bacteria against oxacillin and clindamycin were 60.00%(15/25)and 72.00%(18/25),respectively;the resistance rates against vancomycin and linezolid were 0.Conclusions Gram-positive bacteria are the main pathogens in the pus of the focal area of granulomatous lobular mastitis,and Corynebacterium accounts for the highest proportion.Gram positive bacteria have a very low resistance rate to vancomycin,linezolid,rifampicin,and gentamicin,so the above drugs could be selected for the treatment.