孕晚期和产后1周妇女阴道解脲脲原体和人型支原体感染情况及抗生素敏感结果
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摘要
目的:分析孕晚期至产后1周妇女阴道解脲脲原体和人型支原体感染情况及抗生素敏感结果。方法:将宁波市第七医院300例孕晚期至产后1周的妇女作为研究对象,对其阴道分泌物进行支原体筛查及药敏试验,其中药敏试验的主要抗菌药有左氧氟沙星、环丙沙星、阿奇霉素、罗红霉素、司帕沙星、克拉霉素等。结果:300例患者中,检出支原体209例,感染率为69. 67%。其中,人型支原体单独感染9例(4. 31%),解脲脲原体单独感染149例(71. 29%),二者混合感染51例(24. 40%)。<20岁(9例)、21岁~25岁(81例)、26岁~30岁(71例)、31岁~35(38例)岁、> 35岁(10例)患者出现支原体感染。对于解脲脲原体,氟喹诺酮类药物耐药率显著高于大环内酯类和四环素类,差异具有统计学意义(P <0. 05);对于人型支原体和混合感染,氟喹诺酮类和大环内酯类药物耐药率显著高于四环素类,差异具有统计学意义(P <0. 05);人型支原体和混合感染患者四环素耐药率和大环内酯类耐药率显著高于解脲脲原体,差异具有统计学意义(P <0. 05);解脲脲原体、人型支原体和混合感染患者氟喹诺酮类耐药率差异无统计学意义(P>0. 05)。结论:孕晚期至产后1周的妇女生殖道支原体感染率较高,并且氟喹诺酮类等抗菌药物表现出较高的耐药性,而二代大环内酯类、四环素类抗菌药物的敏感性较高,同时对21岁~30岁的高危人群应积极进行临床干预。
Objective: To analyze the infection and antibiotic sensitivity of Ureaplasma urealyticum( Uu)and Mycoplasma hominis( Mh) in the late pregnancy to a week postpartum. Methods: 300 women in the late pregnancy to aweek postpartum were selected as the research objects. Mycoplasma screening and drug sensitivity were detected,and the main antimicrobial agents used were levofloxacin,ciprofloxacin,azithromycin,roxithromycin,sparfloxacin,clarithromycin and so on. Results: Among the 300 cases,Mycoplasma were detected in 209 cases,an infection rate of 69. 67%,where Mh infection was found in 9 cases( 4. 31%),Uu infection was found in 149 cases( 71. 29%),and mixed infection was found in 51 cases( 24. 40%). There were 9 cases,81 cases,71 cases,38 cases and 10 cases of mycoplasma infection in patients less than 20 years old,21 ~ 25 years old,26 ~ 30 years old,31 ~ 35 years old and 35 years old accordingly. For Uu,the resistance rate of fluoroquinolones was significantly higher than that of macrolides and tetracycline,with statistically significant difference( P < 0. 05). For Mh and mixed infection,the resistance rates of fluoroquinolones and macrolides were significantly higher than those of tetracycline,with statistically significant difference( P < 0. 05). The resistance rate of tetracycline and macrolide in patients with Mh infection and mixed infection were higher than that of Uu( P < 0. 05). There is no statistical significance in the difference among patients with Mh infection,mixed infection and Uu infection regarding as fluoroquinolone resistance rate( P > 0. 05). Conclusions: The higher rate of late pregnancy and postpartum at 1 week of infection in women genital tract mycoplasma,and fluoroquinolones and other antimicrobial agents show high resistance,and the twice generation macrolides,tetracycline antibiotic sensitive drugs,at the same time on the high risk population aged 21 ~ 30 years old should actively carry out clinical intervention.
Objective: To analyze the infection and antibiotic sensitivity of Ureaplasma urealyticum( Uu)and Mycoplasma hominis( Mh) in the late pregnancy to a week postpartum. Methods: 300 women in the late pregnancy to aweek postpartum were selected as the research objects. Mycoplasma screening and drug sensitivity were detected,and the main antimicrobial agents used were levofloxacin,ciprofloxacin,azithromycin,roxithromycin,sparfloxacin,clarithromycin and so on. Results: Among the 300 cases,Mycoplasma were detected in 209 cases,an infection rate of 69. 67%,where Mh infection was found in 9 cases( 4. 31%),Uu infection was found in 149 cases( 71. 29%),and mixed infection was found in 51 cases( 24. 40%). There were 9 cases,81 cases,71 cases,38 cases and 10 cases of mycoplasma infection in patients less than 20 years old,21 ~ 25 years old,26 ~ 30 years old,31 ~ 35 years old and 35 years old accordingly. For Uu,the resistance rate of fluoroquinolones was significantly higher than that of macrolides and tetracycline,with statistically significant difference( P < 0. 05). For Mh and mixed infection,the resistance rates of fluoroquinolones and macrolides were significantly higher than those of tetracycline,with statistically significant difference( P < 0. 05). The resistance rate of tetracycline and macrolide in patients with Mh infection and mixed infection were higher than that of Uu( P < 0. 05). There is no statistical significance in the difference among patients with Mh infection,mixed infection and Uu infection regarding as fluoroquinolone resistance rate( P > 0. 05). Conclusions: The higher rate of late pregnancy and postpartum at 1 week of infection in women genital tract mycoplasma,and fluoroquinolones and other antimicrobial agents show high resistance,and the twice generation macrolides,tetracycline antibiotic sensitive drugs,at the same time on the high risk population aged 21 ~ 30 years old should actively carry out clinical intervention.
引文
[1] Michou IV,Constantoulakis P,Makarounis K,et al. Molecular investigation of menstrual tissue for the presence of Chlamydia trachomatis,Ureaplasma urealyticum and Mycoplasma hominis collected by women with a history of infertility. J Obstet Gynaecol Res,2014,40(1):237-242.
[2] Méndez-Martínez S,García-Carrasco M,Cedillo-Ramírez ML,et al.Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus. Seminars in Respiratory&Critical Care Medicine,2017,36(6):899-913.
[3]叶麾,曾玺,邓泽文,等.女性生殖道解脲脲原体感染及其药敏分析.中华妇幼临床医学杂志(电子版),2017,13(2):210-213.
[4]黄珺,张钧,宋铁军,等.候选致病岛Uu146-Uu150在临床分离解脲脲原体中的检测分析.全科医学临床与教育,2013,11(1):13-16.
[5] Aydogan P,Kahyaoglu S,Saygan S,et al. Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study. Eur Rev Med Pharmacol Sci,2014,18(16):2243-2247.
[6]张岱,刘朝晖.生殖道支原体感染诊治专家共识.中国性科学,2016,25(3):80-82.
[7]全可新.脲原体检测的方法学研究进展.中国男科学杂志,2016,30(3):67-69.
[8] Silwedel C,Speer CP,Glaser K. Ureaplasma-associated prenatal,perinatal,and neonatal morbidities. Expert Rev Clin Immunol,2017,13(11):1073-1087.
[9]沈东华.生殖道支原体599株培养及药敏结果分析.全科医学临床与教育,2014,12(4):458-460.
[10]张艳,李苏利,华川,等.脲原体属感染及相关耐药基因研究.中国感染与化疗杂志,2016,16(1):67-70.
[11]许莉,王家建,方根娟,等.胎膜早破孕妇宫颈支原体和衣原体感染情况及支原体药敏分析.医学研究杂志,2017,46(7):83-86.
[12] Ugoh SC,Nneji LM,Samuel S. Prevalence of Mycoplasma species in urine samples collected from females attending University of Abuja Teaching Hospital,Gwagwalada,FCT-Nigeria. Researcher,2014,6(2):99-104.
[13]韩威婷,贺杉芝.沙眼衣原体、解脲支原体感染对妊娠结局及其新生儿的影响及护理.中国性科学,2013,22(9):62-64.
[14]李小侠,解娟,詹颉,等.围产期胎膜早破与生殖道病原菌感染的分析.现代检验医学杂志,2016,31(4):90-92.
[15] Glaser K,Speer CP. Neonatal CNS infection andinflammation caused by Ureaplasma species:rare or relevant?. Expert Review Anti Infect Ther,2015,13(2):233-248.
[2] Méndez-Martínez S,García-Carrasco M,Cedillo-Ramírez ML,et al.Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus. Seminars in Respiratory&Critical Care Medicine,2017,36(6):899-913.
[3]叶麾,曾玺,邓泽文,等.女性生殖道解脲脲原体感染及其药敏分析.中华妇幼临床医学杂志(电子版),2017,13(2):210-213.
[4]黄珺,张钧,宋铁军,等.候选致病岛Uu146-Uu150在临床分离解脲脲原体中的检测分析.全科医学临床与教育,2013,11(1):13-16.
[5] Aydogan P,Kahyaoglu S,Saygan S,et al. Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study. Eur Rev Med Pharmacol Sci,2014,18(16):2243-2247.
[6]张岱,刘朝晖.生殖道支原体感染诊治专家共识.中国性科学,2016,25(3):80-82.
[7]全可新.脲原体检测的方法学研究进展.中国男科学杂志,2016,30(3):67-69.
[8] Silwedel C,Speer CP,Glaser K. Ureaplasma-associated prenatal,perinatal,and neonatal morbidities. Expert Rev Clin Immunol,2017,13(11):1073-1087.
[9]沈东华.生殖道支原体599株培养及药敏结果分析.全科医学临床与教育,2014,12(4):458-460.
[10]张艳,李苏利,华川,等.脲原体属感染及相关耐药基因研究.中国感染与化疗杂志,2016,16(1):67-70.
[11]许莉,王家建,方根娟,等.胎膜早破孕妇宫颈支原体和衣原体感染情况及支原体药敏分析.医学研究杂志,2017,46(7):83-86.
[12] Ugoh SC,Nneji LM,Samuel S. Prevalence of Mycoplasma species in urine samples collected from females attending University of Abuja Teaching Hospital,Gwagwalada,FCT-Nigeria. Researcher,2014,6(2):99-104.
[13]韩威婷,贺杉芝.沙眼衣原体、解脲支原体感染对妊娠结局及其新生儿的影响及护理.中国性科学,2013,22(9):62-64.
[14]李小侠,解娟,詹颉,等.围产期胎膜早破与生殖道病原菌感染的分析.现代检验医学杂志,2016,31(4):90-92.
[15] Glaser K,Speer CP. Neonatal CNS infection andinflammation caused by Ureaplasma species:rare or relevant?. Expert Review Anti Infect Ther,2015,13(2):233-248.