人工流产后妇科感染的主要病原菌分布和影响因素分析
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摘要
目的分析人工流产后妇科感染的主要病原菌分布和影响因素,指导临床感染防治。方法收集514例人工流产患者临床资料,对患者感染的病原学情况进行检查,并采用K-B法进行耐药性分析,采用统计学分析差异显著性。结果 514例人工流产患者中感染82例,感染率15.95%,分离病原菌58株,其中革兰阴性菌37株,革兰阳性菌16株,真菌5株;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌分别为16、10、7、7、4和2株。大肠埃希菌对环丙沙星、庆大霉素、阿米卡星、氨曲南、万古霉素、诺氟沙星、氧氟沙星、加替沙星、妥布霉素的耐药率分别为6.25%、43.75%、12.5%、6.25%、0.00%、25%、12.5%、0.00%和56.25%;金黄色葡萄球菌环丙沙星、庆大霉素、阿米卡星、氨曲南、万古霉素、苯唑西林、利福平、替考拉宁、克林霉素的耐药率分别为28.57%、42.86%、14.29%、0.00%、14.29%、42.86%、14.29%、0.00%和57.14%。学生、公务员、服务员、工人、无业者、其他职业患者感染率分别为14.95%、6.25%、44.44%、12.07%、18.39%和13.51%。≤30岁和>30岁的患者感染率分别为13.08%和21.76%,初次性行为年龄≤18岁和>18岁的患者感染率分别为22.01%和11.80%,采取和未采取避孕措施的患者感染率分别为12.88%和21.28%,有妇科感染病史和无妇科感染病史的患者感染率分别为20.21%和13.40%,很少清洁外阴和经常清洁外阴的患者感染率分别为24.42%和11.70%,月经期有和没有性行为的患者感染率分别为22.78%和12.28%,流产1次和≥2次的患者感染率分别为11.61%和22.55%,各组患者感染率差异均有统计学意义(P均<0.05)。结论人工流产后妇科感染的主要病原菌类型为大肠埃希菌和金黄色葡萄球菌。患者年龄≥30岁、初次性行为年龄≤18岁、不采取避孕措施、有妇科感染病史、很少清洁外阴、月经期有性行为、流产次数≥2次等是影响感染发生的主要因素。
Objectives To analyze the distribution of major pathogens causing a gynecological infection after an abortion and factors influencing its development in order to guide the clinical prevention and treatment of infections. Methods Clinical data on 514 patients who had an abortion were collected, the prevalence of pathogens infecting those patients was examined, and the drug resistance of those pathogens was analyzed using the K-B method. Statistical analysis was used to determine significant differences. Results Of 514 patients who had an abortion, 82 developed a gynecological infection, for a rate of infection of 15.95%. Fifty-eight strains of pathogen were isolated from patients with an infection, including 37 strains of Gram-negative bacteria(63.79%), 16 strains of Gram-positive bacteria(27.59%), and 5 strains of fungi(8.62%). Gram-negative bacteria included 16 strains of Escherichia coli(27.59%), 10 of Klebsiella pneumoniae(17.24%), 7 of Pseudomonas aeruginosa(12.07%), and 4 of other Gram-negative bacteria(6.90%). Gram-positive bacteria included 7 strains of Staphylococcus aureus(12.07%), 4 of Staphylococcus epidermidis(6.90%), 2 of Enterococcus faecalis(3.45%), and 3 of other Gram-positive bacteria(5.17%). The resistance of 16 strains of E. coli to ciprofloxacin was 6.25%, their resistance to gentamicin was 43.75%, their resistance to amikacin was 12.5%, their resistance to aztreonam was 6.25%, their resistance to vancomycin was 0%, their resistance to norfloxacin was 25%, their resistance to ofloxacin was 12.5%, their resistance to gatifloxacin was 0%, and their resistance to tobramycin was 56.25%. The resistance of 7 strains of S. aureus to ciprofloxacin was 28.57%, their resistance to gentamicin was 42.86%, their resistance to amikacin was 14.29%, their resistance to amitriptyline was 0.00%, their resistance to vancomycin was 14.29%, their resistance to oxacillin was 42.86%, their resistance to rifampicin was 14.29%, their resistance to teicoplanin was 0.00%, and their resistance to clindamycin was 57.14%. The rate of infection was 14.95% among students, 6.25% among civil servants, 44.44% among workers in the service industry, 12.07% among workers, 18.39% among the unemployed, and 13.51% among patients with other jobs. The rate of infection was 13.08% among patients age 30 or younger and 21.76% among patients over the age of 30. The rate of infection was 22.01% among patients who had their first sexual experience at age 18 or younger and 11.80% among patients who had their first sexual experience over the age of 18. The rate of infection was 12.88% among patients taking birth control and 21.28% among patients not taking birth control. The rate of infection was 20.21% among patients with a history of gynecological infections and 13.40% among patients with no such history. The rate of infection was 24.42% among patients who rarely cleaned their vulva and 11.70% among patients who routinely cleaned their vulva. The rate of infection was 22.78% among patients who had sex during menstruation and 12.28% among patients who did not. The rate of infection was 11.61% among patients who had 1 abortion and 22.55% among patients who had 2 or more abortions. Rates of infection differed significantly between the groups of patients. Conclusion The main pathogens causing a gynecological infection were E. coli and S. aureus. In clinical practice, vancomycin and gatifloxacin should be used to treat an infection with E. coli, and amitriptyline and teicoplanin should be used to treat an infection with S. aureus. A gynecological infection often developed after an abortion. Age, having one's first sexual experience at age 18 or younger, not taking contraception, a history of gynecological infections, rarely cleaning one's vulva, having sex during menstruation, and having 2 or more abortions were the main factors affecting the incidence of infection of those infections.
Objectives To analyze the distribution of major pathogens causing a gynecological infection after an abortion and factors influencing its development in order to guide the clinical prevention and treatment of infections. Methods Clinical data on 514 patients who had an abortion were collected, the prevalence of pathogens infecting those patients was examined, and the drug resistance of those pathogens was analyzed using the K-B method. Statistical analysis was used to determine significant differences. Results Of 514 patients who had an abortion, 82 developed a gynecological infection, for a rate of infection of 15.95%. Fifty-eight strains of pathogen were isolated from patients with an infection, including 37 strains of Gram-negative bacteria(63.79%), 16 strains of Gram-positive bacteria(27.59%), and 5 strains of fungi(8.62%). Gram-negative bacteria included 16 strains of Escherichia coli(27.59%), 10 of Klebsiella pneumoniae(17.24%), 7 of Pseudomonas aeruginosa(12.07%), and 4 of other Gram-negative bacteria(6.90%). Gram-positive bacteria included 7 strains of Staphylococcus aureus(12.07%), 4 of Staphylococcus epidermidis(6.90%), 2 of Enterococcus faecalis(3.45%), and 3 of other Gram-positive bacteria(5.17%). The resistance of 16 strains of E. coli to ciprofloxacin was 6.25%, their resistance to gentamicin was 43.75%, their resistance to amikacin was 12.5%, their resistance to aztreonam was 6.25%, their resistance to vancomycin was 0%, their resistance to norfloxacin was 25%, their resistance to ofloxacin was 12.5%, their resistance to gatifloxacin was 0%, and their resistance to tobramycin was 56.25%. The resistance of 7 strains of S. aureus to ciprofloxacin was 28.57%, their resistance to gentamicin was 42.86%, their resistance to amikacin was 14.29%, their resistance to amitriptyline was 0.00%, their resistance to vancomycin was 14.29%, their resistance to oxacillin was 42.86%, their resistance to rifampicin was 14.29%, their resistance to teicoplanin was 0.00%, and their resistance to clindamycin was 57.14%. The rate of infection was 14.95% among students, 6.25% among civil servants, 44.44% among workers in the service industry, 12.07% among workers, 18.39% among the unemployed, and 13.51% among patients with other jobs. The rate of infection was 13.08% among patients age 30 or younger and 21.76% among patients over the age of 30. The rate of infection was 22.01% among patients who had their first sexual experience at age 18 or younger and 11.80% among patients who had their first sexual experience over the age of 18. The rate of infection was 12.88% among patients taking birth control and 21.28% among patients not taking birth control. The rate of infection was 20.21% among patients with a history of gynecological infections and 13.40% among patients with no such history. The rate of infection was 24.42% among patients who rarely cleaned their vulva and 11.70% among patients who routinely cleaned their vulva. The rate of infection was 22.78% among patients who had sex during menstruation and 12.28% among patients who did not. The rate of infection was 11.61% among patients who had 1 abortion and 22.55% among patients who had 2 or more abortions. Rates of infection differed significantly between the groups of patients. Conclusion The main pathogens causing a gynecological infection were E. coli and S. aureus. In clinical practice, vancomycin and gatifloxacin should be used to treat an infection with E. coli, and amitriptyline and teicoplanin should be used to treat an infection with S. aureus. A gynecological infection often developed after an abortion. Age, having one's first sexual experience at age 18 or younger, not taking contraception, a history of gynecological infections, rarely cleaning one's vulva, having sex during menstruation, and having 2 or more abortions were the main factors affecting the incidence of infection of those infections.
引文
[1] 王倩,冯琪,游丽琴.深圳市南山区人工流产女青年性相关知识和性行为调查[J].中国计划生育学杂志,2009,11(5):281-3.
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[3] 陈凯清,孙玉春,陈远秀,等.沙井街道外来女工人工流产患者术后保健知识需求程度调查[J].中国性科学,2013,22(6):32-4.
[4] 黄沁松,李丽珍,符敏,等.妇科腹腔镜手术患者感染病原菌及耐药性分析[J].中华医院感染学杂志,2014(17):4214-5,4218.
[5] 刘慧莹,陈帅印,段广才,等.亚胺培南体外诱导大肠埃希菌MIC变化规律及相关耐药机制探讨[J].中国病原生物学杂志,2018,13(2):155-9.
[6] Sutkin G,Alperin M,Meyn L,et al.Symptomatic urinary tractinfections after surgery for prolapse and/or incontinence[J].Int Urogynecol J,2010,21(8):955-61.
[7] Tuuli MG,Rampersad RM,Carbone JF,et al.Staples comparedwith subcuticular suture for skin closure after cesarean delivery:a systematic review and meta-analysis[J].Obstet Gynecol,2011,117(3):682-90.
[8] Talbot TR.Diabetes mellitus and cardiothoracic surgical siteinfections[J].Am J Infect Control,2005,33(6):353-9.
[9] 李霈,袁丽芬,邓刚.妇科手术腹部切口感染影响因素及预防对策[J].中华医院感染学杂志,2014,24(15):3847-50.
[10] Heilmann C,Schweitzer O,Gerke C,et al.Molecular basis of intercellular adhesion in the biolfilm-forming Staphylococcus epidermidis[J].Mol Microbiol,1996,20(5):1083-91.
[11] Zhang JJ,Zhang YH,Dong ZJ.Investigation on current situation and risk factors of Ttrichmonas vaginalis infection among married women in rural areas[J].J Pathogen Biol,2007,2(1):72-4.
[12] Morgan Linnell SK,Becnel Boyd I,Steffen D,et al.Mechanisms accounting for fluoroyuinolone resistance in Escherichia coli clinical isolates[J].Antimicrob Agents Chemother,2009,53(1):235-41.
[13] 黄艺娜,张铭清,江剑平.大学生婚前性行为和性态度调查分析[J].中国性科学,2012,21(1):19-21.
[14] 任传伟,赵时梅.细菌性阴道炎合并妇科感染性疾病的临床特点[J].中国病原生物学杂志,2018,13(4):421-3.
[15] 吴小梅.未婚女青年意外妊娠的流产术及风险防范[J].中国医药指南,2013,11(10):79-80.
[2] Gilchrist AC,H annaford PC,Frank P,et al.Termination of pregnancy and psychiatric morbidity[J].Br J Psychiatry,2008,167(2):243.
[3] 陈凯清,孙玉春,陈远秀,等.沙井街道外来女工人工流产患者术后保健知识需求程度调查[J].中国性科学,2013,22(6):32-4.
[4] 黄沁松,李丽珍,符敏,等.妇科腹腔镜手术患者感染病原菌及耐药性分析[J].中华医院感染学杂志,2014(17):4214-5,4218.
[5] 刘慧莹,陈帅印,段广才,等.亚胺培南体外诱导大肠埃希菌MIC变化规律及相关耐药机制探讨[J].中国病原生物学杂志,2018,13(2):155-9.
[6] Sutkin G,Alperin M,Meyn L,et al.Symptomatic urinary tractinfections after surgery for prolapse and/or incontinence[J].Int Urogynecol J,2010,21(8):955-61.
[7] Tuuli MG,Rampersad RM,Carbone JF,et al.Staples comparedwith subcuticular suture for skin closure after cesarean delivery:a systematic review and meta-analysis[J].Obstet Gynecol,2011,117(3):682-90.
[8] Talbot TR.Diabetes mellitus and cardiothoracic surgical siteinfections[J].Am J Infect Control,2005,33(6):353-9.
[9] 李霈,袁丽芬,邓刚.妇科手术腹部切口感染影响因素及预防对策[J].中华医院感染学杂志,2014,24(15):3847-50.
[10] Heilmann C,Schweitzer O,Gerke C,et al.Molecular basis of intercellular adhesion in the biolfilm-forming Staphylococcus epidermidis[J].Mol Microbiol,1996,20(5):1083-91.
[11] Zhang JJ,Zhang YH,Dong ZJ.Investigation on current situation and risk factors of Ttrichmonas vaginalis infection among married women in rural areas[J].J Pathogen Biol,2007,2(1):72-4.
[12] Morgan Linnell SK,Becnel Boyd I,Steffen D,et al.Mechanisms accounting for fluoroyuinolone resistance in Escherichia coli clinical isolates[J].Antimicrob Agents Chemother,2009,53(1):235-41.
[13] 黄艺娜,张铭清,江剑平.大学生婚前性行为和性态度调查分析[J].中国性科学,2012,21(1):19-21.
[14] 任传伟,赵时梅.细菌性阴道炎合并妇科感染性疾病的临床特点[J].中国病原生物学杂志,2018,13(4):421-3.
[15] 吴小梅.未婚女青年意外妊娠的流产术及风险防范[J].中国医药指南,2013,11(10):79-80.