妇科恶性肿瘤术后盆腔感染的病原菌分布及耐药性分析  

Analysis of the distribution of pathogenic bacteria and drug resistance of pelvic infection after gynecological malignant tumor surgery

作　　者：张春晓 綦惠娟 ZHANG Chunxiao;QI Huijuan(Affiliated Hospital of Chifeng University,Chifeng 024000,Inner Mongolia,China)

机构地区：[1]赤峰学院附属医院,内蒙古赤峰024000

出　　处：《中国病原生物学杂志》2025年第5期651-655,共5页Journal of Pathogen Biology

基　　金：赤峰学院2023年度教育教学研究项目(No.JYJXY202359)。

摘　　要：目的分析本院妇科恶性肿瘤术后并发盆腔感染病原菌种类及其耐药性,旨在为临床合理使用抗生素提供参考依据。方法选取本院收治的72例妇科恶性肿瘤术后并发盆腔感染患者为本次研究对象。采集患者阴道或宫颈分泌物进行病原菌培养和药敏试验,记录病原菌种类及对不同抗生素的敏感性。采集患者静脉血,测定血清CRP、PCT水平并进行ROC曲线分析,进一步探讨血清CRP、PCT水平在妇科恶性肿瘤术后并发盆腔感染中的诊断价值。结果72例盆腔感染患者检出病原菌74株,其中革兰阴性菌42株,革兰阳性菌25株,真菌7株。革兰阴性菌中,主要为大肠埃希菌(25.68%,19/74),肺炎克雷伯菌、铜绿假单胞菌、产酸克雷伯菌、产气肠杆菌分别为10、5、5、3株。革兰阳性菌中,主要为金黄色葡萄球菌(18.92%,14/74),表皮葡萄球菌、溶血葡萄球菌、屎肠球菌、粪肠球菌分别为5、3、2、1株。真菌中,主要为白色假丝酵母菌(5株)。药敏试验结果显示,革兰阴性菌对阿莫西林的耐药率最高为95.24%,对左氧氟沙星、环丙沙星的耐药率高于50%,对哌拉西林/他唑巴坦、美罗培南的耐药率低于10%,未产生对头孢哌酮/舒巴坦、亚胺培南的耐药株。革兰阳性菌对青霉素的耐药率最高为96%,对红霉素、阿奇霉素、左氧氟沙星的耐药率高于50%,未产生对万古霉素、替考拉宁的耐药株。感染组患者血清CRP水平为(84.17±21.87)mg/L,PCT水平为(9.76±7.03)μg/L,对照组患者血清CRP水平为(62.69±4.53)mg/L,PCT水平为(4.05±3.11)μg/L。两组患者血清CRP、PCT水平差异有统计学意义(P<0.05)。血清CRP水平预测妇科恶性肿瘤术后并发盆腔感染的AUC为0.821(95%CI:0.738~0.904),最佳截断值为71.9 mg/L,敏感度为72.20%,特异性为100%,血清PCT的AUC为0.738(95%CI:0.655~0.822),最佳截断值为7.94μg/L,敏感度为55.60%,特异性为88.60%,联合指标的AUC为0.834(95%CI:0.755~0.913),敏感度为75.Objective The types of pathogenic bacteria causing pelvic infections after gynecological malignant tumor surgery in our hospital and their drug resistance were analyzed to provide a reference basis for the rational use of antibiotics in clinical practice.Methods 72 patients with pelvic infection complicated after gynecological malignant tumor surgery admitted to our hospital were selected as the subjects of this study.The vaginal or cervical secretions of the patients were collected for the culture of pathogenic bacteria and drug sensitivity tests,and the types of pathogenic bacteria and their sensitivities to different antibiotics were recorded.The venous blood of the patients was collected to measure the levels of serum C-reactive protein(CRP)and procalcitonin(PCT),and the receiver operating characteristic(ROC)curve analysis was carried out to further explore the diagnostic value of the levels of serum CRP and PCT in pelvic infection complicated after gynecological malignant tumor surgery.Results A total of 74 strains of pathogenic bacteria were detected in 72 patients with pelvic infection.Among them,there were 42 strains of Gram-negative bacteria,25 strains of Gram-positive bacteria and 7 strains of fungi.Among the Gram-negative bacteria,Escherichia coli was the main one(25.68%,19/74).There were 10 strains of Klebsiella pneumoniae,5 strains of Pseudomonas aeruginosa,5 strains of Klebsiella oxytoca and 3 strains of Enterobacter aerogenes respectively.Among the Gram-positive bacteria,Staphylococcus aureus was the main one(18.92%,14/74).There were 5 strains of Staphylococcus epidermidis,3 strains of Staphylococcus haemolyticus,2 strains of Enterococcus faecium and 1 strain of Enterococcus faecalis respectively.Among the fungi,Candida albicans was the main one.The results of the drug sensitivity test showed that among Gram-negative bacteria,the highest resistance rate to amoxicillin was 95.24%.The resistance rates to levofloxacin and ciprofloxacin were higher than 50%.The resistance rates to piperacillin/tazobact

关 键 词：恶性肿瘤 盆腔感染 病原菌 耐药性 

分 类 号：R737.3[医药卫生—肿瘤]