胎膜早破与正常胎膜破裂患者羊水病原菌分布及药敏分析  

Distribution of pathogens and drug susceptibility of pathogenic bacteria in amniotic fluid in patients with premature rupture of membranes and normal mature rupture of membranes

作　　者：刘敏雪 黄丽英[1] 王双杰[1] 梁嘉慧 曾尚娟[1] 岑贞娇[1] 黄战[1] 张欢 LIU Minxue;HUANG Liying;WANG Shuangjie;LIANG Jiahui;ZENG Shangjuan;CEN Zhenjiao;HUANG Zhan;ZHANG Huan(Department of Laboratory Medicine,the Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi 530000,China)

机构地区：[1]广西壮族自治区妇幼保健院检验科,南宁530000

出　　处：《重庆医学》2022年第7期1147-1151,共5页Chongqing medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190836);广西壮族自治区妇幼保健院2018年“育苗计划”青年项目(GXWCH-YMJH-2018008);广西临床重点专科(医学检验科)建设项目。

摘　　要：目的对比分析胎膜早破与产程开始后胎膜破裂患者羊水细菌与真菌分布及耐药特征,为临床提供病原学依据。方法回顾性分析该院2018-2019年羊水培养情况,将羊水培养阳性患者分为胎膜早破组与产程开始后胎膜破裂组(正常胎膜破裂组),比较2组患者的基本情况、羊水检出病原菌的构成及主要致病菌的药敏特征。结果胎膜早破组共纳入98例,正常胎膜破裂组共纳入197例。2组羊水检出最多的致病菌均为革兰阴性杆菌(55.45%vs.49.56%,P>0.05),排名前3位的革兰阴性杆菌为大肠埃希菌、肺炎克雷伯菌、阴道加德纳菌。革兰阳性球菌是羊水第二大类病原菌(32.73%vs.30.97%,P>0.05),以无乳链球菌为主。另外,2组羊水检出的真菌比例差异有统计学意义(2.73%vs.14.60%,P<0.001),胎膜早破组检出白念珠菌比例较正常胎膜破裂组低(2.73%vs.13.27%,P=0.002)。2组检出的无乳链球菌对青霉素类、头孢类、糖肽类及碳青酶烯类抗生素均敏感,而对红霉素、克林霉素及四环素耐药率较高,且胎膜早破组无乳链球菌对四环素的耐药率远低于正常胎膜破裂组(40.00%vs.82.61%,P=0.014)。另外,胎膜早破组检出大肠埃希菌对氨苄西林、复方新诺明、环丙沙星及头孢类抗生素耐药率均比正常胎膜破裂组高(P<0.05),且胎膜早破组检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的比例远高于正常胎膜破裂组(56.10%vs.18.07%,P<0.001)。结论产程开始后胎膜破裂患者羊水检出念珠菌较胎膜早破患者高;胎膜早破患者羊水检出的大肠埃希菌对抗生素耐药率更高。Objective To compare and analyze the pathogenic organism and its antibiotics sensitivity cultured from amniotic fluid between premature rupture of membranes(PROM)maternal patients and normal mature rupture of membranes(NROM)maternal patients and to provide microbiology references for clinical empirical medication.Methods The amniotic fluid materials of this Hospital of Guangxi from 2018 to 2019 were retrospective analyzed.The amniotic fluid positive culture patients were divided into the PROM group and the NROM group.The basic information,composition rates of pathogenic organism and antibiotics sensitivity of the major pathogenic bacteria were compared between the two groups.Results A total of 98 cases were included in the PROM group and 197 cases in the NROM group.Gram-negative(G-)bacillus were the most in both groups(55.45%vs.49.56%,P>0.05)and the top three were Escherichia coli,Klebsiella pneumoniae and Gardnerella vaginalis.The second most bacteria cultured from amniotic fluid were Gram-positive(G+)coccus(32.73%vs.30.97%,P>0.05),among which Streptococcus agalactiae was the main.In addition,there was a significant difference in the percentage of fungi detected in amniotic fluid between the twogroups(2.73%vs.14.60%,P<0.001).The rate of candida albicans in the PROM group were less than that in the NROM group(2.73%vs.13.27%,P=0.002).Streptococcus agalactiae of the both groups were sensitive to penicillins,cephalosporins,glycopeptides and carbapenems.But Streptococcus agalactiae from the PROM group were less resistant to tetracycline than that in the NROM group(40.00%vs.82.61%,P=0.014).Otherwise,Escherichia coli in the PROM group were more resistant to ampicillin,sulfamethoxazole,ciprofloxacin and cephalosporins than that in the NROM group(P<0.05).Also,the positive rate of ESBLs-produced Escherichia coli in the PROM group were higher than that in the NROM group(56.10%vs.18.07%,P<0.001).Conclusion Candida albicans in amniotic fluid of the NROM maternal patients were more than the PROM maternal patients.The antibiot

关 键 词：胎膜早破 产程开始后胎膜破裂 羊水 病原菌 药敏试验 

分 类 号：R115[医药卫生—公共卫生与预防医学]