胎膜早破合并宫内感染病原菌分布特点及危险因素分析  

Analysis of the distribution characteristics of pathogenic bacteria and risk factors in premature rupture of fetal membranes complicated with intrauterine infection

作　　者：常倩 刘召防 滕玉翠[1] 王宏霞 轩书侠 CHANG Qian;LIU Zhaofang;TENG Yucui;WANG Hongxia;XUAN Shuxia(Department of Obstetrics and Gynecology,Second People's Hospital of Liaocheng,Liaocheng 252600,Shandong,China)

机构地区：[1]聊城市第二人民医院产一科,山东聊城252600

出　　处：《中国病原生物学杂志》2025年第5期623-627,共5页Journal of Pathogen Biology

摘　　要：目的探讨胎膜早破孕妇合并宫内感染的病原菌分布特征及其相关危险因素,为临床预防及治疗提供科学依据。方法选取本院接诊的63例胎膜早破合并宫内感染患者及同期63例胎膜早破未合并宫内感染患者为本次研究对象。采集宫内感染患者羊水标本,进行细菌培养和药敏试验,分析病原菌种类及耐药情况。同时,采用Logistic回归分析法评估相关危险因素,以期为临床防治工作提供参考。结果63例宫内感染患者中共分离出72株病原菌。其中,55例患者检出1株病原菌,7例检出2株,1例检出3株。病原菌中,革兰阴性菌占55.56%,主要为大肠埃希菌(23.61%),其次是肺炎克雷伯菌(9.72%)和阴道加德纳菌(6.94%)。革兰阳性菌占31.94%,以无乳链球菌(19.44%)为主。真菌占12.5%,主要是白色假丝酵母菌(8.33%)。大肠埃希菌对氨苄西林的耐药率最高为88.24%,对头孢呋辛的耐药率为58.82%,对头孢他啶、美罗培南、亚胺培南、莫西沙星的耐药率较低,分别为17.65%、11.76%、5.88%、17.65%,未检出对阿米卡星的耐药株。无乳链球菌对克林霉素的耐药率最高为78.57%,对红霉素、四环素的耐药率分别为71.43%、64.29%,对氯霉素的耐药率较低为7.14%,未检出对青霉素G、氨苄西林、万古霉素的耐药株。单因素分析表明,两组患者在破膜孕周、破膜后待产时间、阴道检查次数及瘢痕子宫方面存在显著差异(P<0.05),而年龄、体重指数和分娩史差异无统计学意义(P>0.05)。进一步的二元Logistic回归分析显示,破膜孕周<33周、破膜后待产时间≥2 d、破膜后行阴道检查次数≥4次、瘢痕子宫均为宫内感染发生的独立危险因素(P<0.05)。感染组患者中,产褥感染、胎盘早剥、胎儿呼吸窘迫、新生儿窒息、新生儿感染和缺氧性脑病的发生率分别为28.57%、14.29%、12.7%、17.46%、23.81%和20.63%。对照组中,产褥感染、胎盘早剥、胎儿呼吸窘迫、新生儿�Objective To explore the distribution characteristics of pathogenic bacteria and related risk factors in pregnant women with premature rupture of fetal membranes complicated with intrauterine infection,so as to provide scientific basis for clinical prevention and treatment.Methods 63 patients with premature rupture of fetal membranes complicated with intrauterine infection and 63 patients with premature rupture of fetal membranes without intrauterine infection admitted to our hospital during the same period were selected as the research objects of this study.Amniotic fluid specimens from patients with intrauterine infection were collected for bacterial culture and drug sensitivity test to analyze the types of pathogenic bacteria and drug resistance.At the same time,Logistic regression analysis was used to evaluate relevant risk factors in order to provide a reference for clinical prevention and treatment.Results A total of 72 strains of pathogenic bacteria were isolated from 63 patients with intrauterine infection.Among them,55 patients were detected with 1 strain of pathogenic bacteria,7 patients were detected with 2 strains,and 1 patient was detected with 3 strains.Among the pathogenic bacteria,Gram-negative bacteria accounted for 55.56%,mainly Escherichia coli(23.61%),followed by Klebsiella pneumoniae(9.72%)and Gardnerella vaginalis(6.94%).Gram-positive bacteria accounted for 31.94%,mainly Streptococcus agalactiae(19.44%).Fungi accounted for 12.5%,mainly Candida albicans(8.33%).The resistance rate of Escherichia coli to ampicillin was the highest at 88.24%.The resistance rate to cefuroxime was 58.82%.The resistance rates to ceftazidime,meropenem,imipenem,and moxifloxacin were relatively low,which were 17.65%,11.76%,5.88%,and 17.65% respectively.No resistant strains to amikacin were detected.The resistance rate of Streptococcus agalactiae to clindamycin was the highest at 78.57%.The resistance rates to erythromycin and tetracycline were 71.43% and 64.29%respectively.The resistance rate to chloramphenicol was re

关 键 词：胎膜早破 宫内感染 病原菌 危险因素 妊娠结局 

分 类 号：R714.21[医药卫生—妇产科学]