84例产褥感染的临床特点及常见致病微生物耐药性分析  

Analysis on clinical features of 84 patients with puerperal infection and drug resistance of common pathogenic microorganisms

作　　者：戴宜霏 余春风 孙杨芳 柴芸 DAI Yifei;YU Chunfeng;SUN Yangfang;CHAI Yun(Department of Obstetrics,Hangzhou Hospital of Obstetrics and Gynecology,Hangzhou310000,China)

机构地区：[1]杭州市妇产科医院产科,浙江杭州310000

出　　处：《中国现代医生》2020年第31期130-133,141,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020383231)。

摘　　要：目的研究产褥感染的危险因素及常见致病微生物耐药情况,为临床治疗提供参考。方法回顾性分析我院2017年1月~2019年12月发生的84例产褥感染病例的临床资料,与同时期未发生产褥感染的200例产妇进行对照研究,分析产褥感染的影响因素,并对分离获得的致病微生物进行耐药性分析。结果感染组妊娠糖尿病、产钳助产、宫口开全后中转剖宫产患者的分布率高于对照组,差异有统计学意义(P<0.05);经多因素Logistic回归分析,妊娠糖尿病是产褥感染的独立影响因素(P<0.05)。本研究中共检出致病微生物40株,其中革兰阴性菌13株(占32.50%),革兰阳性菌10株(占25.00%),支原体16株(占40.00%),衣原体1株(占2.50%),革兰阴性菌中以大肠埃希菌最常见,对二代头孢菌素类抗生素耐药率20%。革兰阳性菌以金黄色葡萄球菌最常见,对青霉素及头孢菌素耐药率高,未发现对亚胺培南及万古霉素耐药。结论产钳助产、妊娠糖尿病、宫口开全后中转剖宫产是产褥感染可能的危险因素,其中,妊娠糖尿病是产褥感染的独立危险因素。目前临床常见致病微生物谱及耐药率未发生明显变化。Objective To research the risk factors of puerperal infection and drug resistance of common pathogenic microorganisms,so as to provide reference for clinical treatment.Methods The clinical data of 84 patients with puerperal infection admitted to our hospital from January 2017 to December 2019 were analyzed retrospectively.Compared with 200 patients without puerperal infection in the same period,the related factors of puerperal infection were analyzed,and the drug resistance of isolated pathogenic microorganisms was analyzed.Results The distribution rates of patients with gestational diabetes mellitus,forceps delivery and cesarean section after uterine neck whole opened in the infection group were higher than those in the control group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that gestational diabetes mellitus was an independent impacting factor of puerperal infection(P<0.05).A total of 40 pathogenic microorganisms were detected in the research,among which 13 strains(32.50%)were Gram-negative bacteria,10 strains(25.00%)were Gram-positive bacteria,16 strains(40.00%)were mycoplasma and 1 strain(2.50%)was chlamydia.Escherichia coli was the most common Gram-negative bacteria,and its resistance rate to second-generation cephalosporins was 20%.Staphylococcus aureus was the most common Gram-positive bacteria,with high resistance to penicillin and cephalosporin,but no resistances to imipenem and vancomycin were found.Conclusion Birth forceps delivery,gestational diabetes mellitus,and cesarean section after uterine neck whole opened are possible risk factors of puerperal infection,and gestational diabetes mellitus is an independent risk factor of puerperal infection.At present,the spectrum and drug resistance rate of common clinical pathogenic microorganisms have not changed significantly.

关 键 词：产褥感染 妊娠糖尿病 宫口开全 产钳助产 病原微生物 

分 类 号：R714[医药卫生—妇产科学]