老年女性子宫切除术后阴道病原菌分布特征及药敏结果分析  

Distribution and drug resistance of vaginal pathogens in elderly women after hysterectomy

作　　者：周璘[1] 熊刻勤 栾婷 ZHOU Lin;XIONG Keqin;LUAN Ting(Department of Gynecology,Women’s Hospital of Nanjing Medical University(Nanjing Women and Children’s Healthcare Hospital),Nanjing 210004,China;Department of Clinical Medicine,Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)妇科,江苏省南京市210004 [2]湖北医药学院临床医学系,湖北省十堰市442000

出　　处：《实用老年医学》2024年第12期1224-1228,共5页Practical Geriatrics

基　　金：国家自然科学基金资助项目(82204469)。

摘　　要：目的分析老年女性子宫切除术后阴道病原菌分布及药敏情况,为临床上围手术期抗生素的合理选择提供依据。方法以2022年1-12月南京医科大学附属妇产医院妇科电子病历为数据来源,对行子宫切除术并且有术后阴道分泌物培养结果的347例老年病例进行回顾分析,对其临床特征、术后感染指标、阴道病原菌分布及耐药情况等进行分析。结果老年女性行子宫切除术后阴道检出革兰氏阴性菌多于革兰氏阳性菌,其中检出最多的为大肠埃希菌(34.21%),其次为粪肠球菌(28.42%)、肺炎克雷伯菌(5.26%)。不同年龄、不同术式、不同病种病人术后阴道病原菌分布差异无统计学意义,不同子宫切除范围病人阴道病原菌分布差异有统计学意义(P<0.05)。革兰氏阴性菌组术后发热多见。药敏结果显示,60.00%以上大肠埃希菌及肺炎克雷伯菌对三代以内头孢菌素及青霉素类耐药,而对β-内酰胺/β-内酰胺酶抑制剂复合物耐药率低于5%,对碳青霉烯类药物无耐药。老年女性子宫切除术后阴道病原菌总多重耐药率为80.00%(140/175)。结论老年女性子宫切除术后阴道更易检出革兰氏阴性菌,其中最易检出大肠埃希菌,且病原菌总多重耐药率较高。老年女性子宫切除病人术后升级使用抗生素时,推荐首先选择β-内酰胺/β-内酰胺酶抑制剂复合物,尽量避免直接使用碳青霉烯类药物。Objective To analyze the distribution of vaginal pathogens and drug resistance in the elderly women after hysterectomy,and to provide a reference for the reasonable selection of perioperative antibiotics.Methods A retrospective analysis was conducted on the clinical data of 347cases of elderly women admitted to Women’s Hospital of Nanjing Medical University from January to December 2022 who underwent hysterectomy and received the detection of postoperative vaginal secretion culture.The clinical characteristics,postoperative infection indicators,distribution of vaginal pathogens and drug resistance results were analyzed.Results There were more gram-negative bacteria than gram-positive bacteria detected in the vagina of the elderly women after hysterectomy,among which Escherichia coli(34.21%)was the most,followed by Enterococcus faecalis(28.42%)and Klebsiella pneumoniae(5.26%).There was no significant difference in the distribution of vaginal pathogens in the patients with different age,operation methods and diseases,but there was significant difference in the distribution of vaginal pathogens in the patients with different hysterectomy ranges(P<0.05).Moreover,postoperative fever was more common in gram-negative bacteria group.The results of drug sensitivity showed that more than 60.00%of Escherichia coli and Klebsiella pneumoniae were resistant to cephalosporins and penicillins,while the resistance rate ofβ-lactam/β-lactamase inhibitor complex was less than 5%,and no resistance to carbapenem was found.The total multiple drug resistance rate of vaginal pathogens in the elderly women after hysterectomy was 80.00%(140/175).Conclusions Gram-negative bacteria are more easily detected in the vagina of elderly women after hysterectomy,and Escherichia coli is the most easily detected.The total multiple drug resistance rate of pathogenic bacteria is high.When upgrading the use of antibiotics in elderly women after hysterectomy,β-Lactam/β-Lactamase inhibitor complex is recommended,and the direct use of carbapenems sho

关 键 词：病原菌 子宫切除术 老年人 耐药性 

分 类 号：R619.3[医药卫生—外科学]