江汉地区3812例育龄妇女阴道分泌物病原菌分布及耐药性分析

Analysis of pathogens in 3,812 women of childbearing age in Jianghan District and their drug resistance

目的了解江汉地区妇女阴道内病原菌分布及耐药情况,为阴道炎的治疗提供参考。方法 2016年1月至2018年1月在本院接受孕前检查及妇女两癌筛查的育龄妇女3812例,取阴道分泌物,按照《全国临床检验操作规程》采用常规方法进行病原菌的分离培养,分析判定阴道清洁度、病原菌种类并检测其药物敏感性。结果 3812例患者的送检标本中清洁度为Ⅰ、Ⅱ、Ⅲ、Ⅳ分别占11.82%、50.11%、29.14%和8.93%。其中清洁度为Ⅲ者阴道炎发生率较高,为97.15%,与其他清洁度组阴道炎发生率0～88.24%相比差异有统计学意义(χ~2=3 236.575,P<0.05)。检出革兰阴性(G^-)菌577株,占39.77%;革兰阳性(G^+)菌410株,占28.26%;真菌517株,占35.63%;支原体48株,占3.31%。G^-菌对磺胺类、氟喹诺酮类、氨基糖苷类和第3代头孢耐药率较高,为。G^+菌对青霉素、复方磺胺甲噁唑和庆大霉素耐药率较高,为50.1%～96.3%。真菌中的白色假丝酵母菌对伊曲康唑、咪康唑的耐药率分别为10.20%和8.50%。结论江汉地区女性阴道分泌物培养病原菌以G^-菌和真菌占优势,大肠埃希菌、金黄色葡萄球菌对头孢青霉素等类抗生素均有较高耐药性,因此在治疗阴道炎时应通过病原菌检查和药敏试验选择敏感抗菌药物,以达到合理用药的目的。

Objective To ascertain the distribution and drug resistance of pathogens in the vaginas of women in the Jianghan area in order to provide data for prompt treatment of vaginitis. Methods Vaginal secretions were collected from a total of 3,812 women of childbearing age who had undergone pre-pregnancy screening and two cancer screenings at this Hospital from January 2016 to January 2018. Pathogens were isolated and routinely cultured according to the 'National Guide to Clinical Laboratory Procedures.' Vaginal cleanliness, types of pathogens, and their drug sensitivity were determined. Results Based on the samples from the 3,812 patients, vaginal cleanliness was Grade I in 11.82%, Grade II in 50.11%, Grade III in 29.14%, and Grade IV in 8.93%. The incidence of vaginitis was higher(97.15%) in patients with Grade III or IV vaginal cleanliness.The incidence of vaginitis was 0-88.24% in patients with other grades of vaginal cleanliness, and the incidence of vaginitis differed significantly(χ~2=3236.575, P<0.05). Five hundred and seventy-three strains of Gram-negative bacteria were detected, accounting for 39.77% of the pathogens detected. Four hundred and ten strains of Gram-positive strains were detected, accounting for 28.26% of the pathogens detected. Five hundred and seventeen strains of fungi were detected, accounting for 35.63% of the pathogens detected. Forty-eight strains of Mycoplasma were detected, accounting for 3.31%. of the pathogens detected. Gram-negative bacteria had a high resistance to sulfonamides, fluoroquinolones, aminoglycosides, and third-generation cephalosporins. Gram-positive bacteria had a high resistance to penicillin, sulfamethoxazole compounds, and gentamicin, ranging from 50.1% to 96.3%. Candida albicans was resistant to itraconazole at a rate of 10.20% and to miconazole at a rate of 8.50%. Conclusion The pathogens most often detected in vaginal secretions from women at this Hospital were Gram-negative bacteria and fungi. Escherichia coli and Staphylococcus aureus are highly resistant to cephalosporin and other antibiotics. Pathogen detection and susceptibility testing play an important role in clinical diagnosis and treatment if vaginitis.