先兆流产孕妇宫颈分泌物菌群分布特点及对妊娠结局的影响  

Distribution characteristics of cervical secretion flora in pregnant women with threatened abortion and the influence on pregnancy outcome

作　　者：姜天华[1] 赵黎[1] 胡萍[1] JIANG Tian-Hua;ZHAO Li;HU Ping(People's Hospital of Deyang City,Deyang,Sichuan 618000,China)

机构地区：[1]德阳市人民医院

出　　处：《中国妇幼保健》2019年第15期3532-3536,共5页Maternal and Child Health Care of China

基　　金：四川省卫计委重大科研项目(2018ZD054)

摘　　要：目的探讨先兆流产孕妇宫颈分泌物菌群分布特点及对妊娠结局的影响,为临床治疗提供参考依据。方法选取2016年6月-2017年12月德阳市人民医院收治的先兆流产孕妇400例,采集宫颈分泌物,常规进行细菌培养、真菌培养及药敏试验,根据培养结果分为观察组(检出致病菌)164例,对照组(未检出致病菌)236例,比较两组致病菌分布和耐药性特点,并随访至妊娠结束,记录足月产、胎膜早破、早产、流产发生情况e结果164例(41.00%)先兆:产孕妇培养出致病菌,共194株,其中细菌104株,以大肠埃希菌、金黄色葡萄球菌最常见;真菌90株,以白色假丝酵母菌沿常见。宫颈分泌物细菌对头孢西丁的耐药率最高,其次为头孢曲松、庆大霉素;对万古霉素未检出耐药,其次为阿米卡星、亚胺培南。其中大肠杆菌、金黄色葡萄球菌、屎肠球菌对万古霉素敏感性最高,表皮葡萄球菌、阴沟肠杆菌对万古霉素、阿米卡星敏感性最高。宫颈分泌物真菌对伊曲康唑、伏立康唑、氟康唑的耐药率较高,对两性霉素B、5-氟胞嘧啶的耐药率较低。其中白色假丝酵母菌、克柔假丝酵母菌对两性霉素B敏感性最高,光滑假丝酵母菌对5-氟胞嘧啶敏感性最高。观察组孕妇不良妊娠结局发生率明显高于对照组,差异有统计学意义(P<0.05);观察组足月分娩率明显低于对照组,胎膜早破、流产发生率明显高于对照组,差异有统计学意义(均P<0.05)。结论本地区先兆流产孕妇宫颈分泌物致病菌感染率偏高,细菌感染多为大肠埃希菌,真菌感染多为白色假丝酵母菌;感染可明显增加先兆流产孕妇的不良妊娠结局,应根据药敏试验结果合理选用抗生素治疗。Objective To explore the distribution characteristics of cervical secretion flora in pregnant women with threatened abortion and the influence on pregnancy outcome,provide a reference basis for clinical treatment.Methods A total of 400 pregnant women with threatened abortion treated in People's Hospital of Deyang City from June 2016 to December 2017 were selected.Cervical secretion samples were collected,bacterial culture,fungal culture,and drug sensitive test were performed.According to the culture results,the pregnant women were divided into observation group(164 pregnant women,pathogenic bacteria were detected)and control group(236 pregnant women,non-pathogenic bacteria were detected).The distribution and drug resistanccj of pathogenic bacteria were compared between the two groups,the pregnant women in the two groups were followed up until the end of pregnancy.The occurrence rates of full-term labor,premature rupture of fetal membranes,premature delivery,and al>ortion were recorded.Results Among 164 pregnant women(41.00%)with threatened abortion,194 strains of pathogenic bacteria were detected,including 104 strains of bacteris(Escherichia coli and Staphylococcus aureus were the most common types)and 90 strains of fungus(Candida albicans was the most common type).The drug resistance rate of bacteria to cefoxitin was the highest,followed by ceftriaxone and gentamicin,the drug sensitive rate to vancomycin was the highest,followed by amikacin and imipenem.The drug sensitive rates of Escherichia coli.Staphylococcus aureus,and Enterococcus faecium to vancomycin were the highest.The drug sensitive rates of Staphylococcus epidermidis and Enterobacter cloacae to vancomycin and amikacin were the highest.The drug resistance rates of fungi to itraconazole,voriconazole,and fluconazole were higher,and the drug resistance rates to amphotericin B and 5-fluorocytosine were lower.The dnig resistance rates of Candida albicans and Candida krusei to amphotericin B were the highest,the drug resistance rate of Candida glabrata to 5-

关 键 词：先兆流产 宫颈分泌物 细菌感染 真菌感染 耐药性 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]