产妇重症产褥感染病原学特征及疗效  

Etiological characteristics of puerpera with severe puerperal infection and therapeutic effect

作　　者：孙亚妮 赵静[1] 雷静[1] 孙红艳 吕海荣[1] SUN Ya-ni;ZHAO Jing;LEI Jing;SUN Hong-yan;LYU Hai-rong(Xi'an Fourth Hospital,Xi'an,Shaanxi 710004,China)

机构地区：[1]西安市第四医院妇产科,陕西西安710004

出　　处：《中华医院感染学杂志》2021年第10期1581-1585,共5页Chinese Journal of Nosocomiology

基　　金：西安市第四人民医院科研孵化基金项目(FZ-42)。

摘　　要：目的探讨重症产褥感染主要病原菌药敏特点及针对血培养、宫颈分泌物培养结果进行治疗的效果.方法选择2017年4月-2020年4月西安市第四医院妇产科收治的重症产褥感染产妇100例作为研究对象,随机将其分为研究组(n=50)和对照组(n=50).对拟诊重症产褥感染的产妇分别进行宫颈分泌物培养及血液培养,对血液培养结果病原特点及主要检出病原菌药敏结果进行分析.对照组患者在血培养结果得出前一直采用经验性治疗,研究组在血培养结果得出前按照宫颈分泌物培养结果进行治疗,比较两组抗感染治疗效果、平均住院时间、抗感染花费及住院总花费.结果100例患者最终送检血培养瓶数为200瓶,共分离得到病原菌17株,检出率10.56%;其中革兰阴性菌9株,占52.94%,革兰阳性菌7株,占41.18%,真菌1株,占5.88%;主要检出革兰阴性菌大肠埃希菌对头孢唑林、头孢曲松、氨苄西林耐药率均为60.00%,对厄他培南、亚胺培南、阿米卡星耐药率均为0.00%,主要检出革兰阳性菌金黄色葡萄球菌对氨苄西林、青霉素G、红霉素、克林霉素、四环素耐药率均为100.00%,对利奈唑胺、万古霉素耐药率均为0.00%;在血培养结果得出前,研究组感染控制总有效率高于对照组(χ^(2)=3.843,P=0.049);研究组患者平均住院天数、抗感染花费、住院总花费均低于对照组(P<0.05).结论产妇重症产褥感染检出病原菌以大肠埃希菌和金黄色葡萄球菌为主,应根据医院药敏特点进行针对性用药,在培养结果得出前通过宫颈分泌物培养结果指导抗生素用药比经验性用药感染控制效果好,可缩短住院时间及降低住院成本.OBJECTIVE To explore the drug susceptibility characteristics of major pathogens isolated from puerpera with severe puerperal infection and analyze the consistency of blood culture and secretion culture.METHODS A total of 100 puerpera with severe puerperal infection who were treated in obstetrics and gynecology department of Xi′an Fourth Hospital from Apr 2017 to Apr 2020 were recruited as the study subjects and randomly divided into the study group with 50 cases and the control group with 50 cases.The cervical secretion culture and blood culture were carried out for the puerpera who were diagnosed with severe puerperal infection,the etiological characteristics of blood culture and results of drug susceptibility testing for the major pathogens were observed.The control group was not treated with experimental therapy until the result of blood culture was available,while the study group was treated based on the result of culture of cervical secretions before the result of blood culture was available.The effect of anti-infection treatment,average length of hospital stay,cost of anti-infection treatment and total cost of hospital stay were compared between the two groups.RESULTS Totally 200 bottles of blood specimens that were collected from 100 patients were finally submitted for blood culture.A total of 17 strains of pathogens were isolated,with the isolation rate 10.56%;there were 9(52.94%)strains of gram-negative bacteria,7(41.18%)strains of gram-positive bacteria and 1(5.88%)strain of fungus.The drug resistance rates of the major species of gram-negative bacteria Escherichia coli to cefazolin,ceftriaxone and ampicillin were 60.00%,the drug resistance rates to ertapenem,imipenem and amikacin were 0.The drug resistance rates of the major species of gram-positive bacteria Staphylococcus aureus to ampicillin,penicillin G,erythromycin,clindamycin and tetracycline were 100.00%,the drug resistance rates to linezolid and vancomycin were 0.The total effective rate of control of infection of the study group was significa

关 键 词：产褥感染 药物敏感性 病原特点 血培养 宫颈分泌物培养 

分 类 号：R714.62[医药卫生—妇产科学]