细菌性阴道病病原学调查
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摘要
目的了解细菌性阴道炎(BV)病原学特征,为疾病诊治提供依据。方法回顾性分析2017-2018年本院诊断和治疗的226例BV患者资料。无菌采集患者阴道炎标本,对病原菌培养、鉴定,K-B纸片法进行药敏试验,判读依据CLSI 2017。观察阴道加德纳菌生物膜生长情况,并进行环丙沙星耐受性试验。结果 226例BV患者按年龄分布:≤20岁5例,21～岁72例,31～岁83例,41～岁64例,≥51岁2例。职业分布:农民71例,工人53例,服务人员39例,文职人员28例,教师16例,公务员13例,学生6例。226例患者中单一感染192例,双重感染34例。共培养出致病菌260株,其中革兰阴性菌157株,革兰阳性菌103株。革兰阴性菌对头孢他啶、头孢吡肟、诺氟沙星、左氧氟沙星、加替沙星、阿米卡星耐药的程度依次为:38株(24.20%),37株(23.57%),50株(31.85%),34株(21.66%),8株(5.10%)和2株(1.27%),未对美罗培南和亚胺培南产生耐药性。革兰阳性菌对诺氟沙星、左氧氟沙星、加替沙星、罗红霉素、阿奇霉素、麦迪霉素和万古霉素耐药情况依次为:38株(36.89%),28株(27.18%),9株(8.74%),15株(14.56%),12株(11.65%),4株(3.88%)和1株(0.97%),未产生对替考拉宁耐药。41株阴道加德纳菌18株形成生物膜。生物膜阳性菌11株耐药,耐药率61.11%(11/18),阴性菌6株耐药,耐药率26.09%(6/23),差异有统计学意义(χ~2=5.103 4,P<0.05)。结论大肠埃希菌是BV主要致病菌,大环内酯类抗生素抑菌效果较好;阴道加德纳菌形成生物膜后对抗生素耐受性有所提升。
Objectives To investigate the etiology of bacterial vaginosis(BV) and provide a strong basis for the prevention and treatment of BV. Methods Two hundred and twenty-six patients diagnosed with and treated for BV at this Hospital from January 2017 to December 2018 were retrospectively analyzed. Samples from patients with vaginitis were collected aseptically, and the bacteria were cultured and identified. The K-B disc method was used to test the susceptibility of pathogenic bacteria, and results were interpreted based on the 2017 guidelines of the CLSI. The formation of Gardnerella vaginalis biofilm was observed, and susceptibility to ciprofloxacin was tested. Results By age group, the 226 patients with BV consisted of 5 patients under the age of 20, 72 between the ages of 21 and 30, 83 between the ages of 31 and 40, 64 between the ages of 41 and 50, and 2 over the age of 51. By occupational, 71 patients were farmers, 53 were workers, 39 worked in the service industry, 28 were civil servants, 16 were teachers, 13 were public employees, and 6 were students. One hundred and ninety-two patients had a single infection and 34 had a double infection. Two hundred and sixty strains of pathogenic bacteria were cultured, including 157 strains of Gram-negative bacteria and 103 strains of Gram-positive bacteria. Thirty-eight strains(24.20%) of Gram-negative bacteria were resistant to ceftazidime, 37(23.57%) were resistant to cefepime, 50(31.85%) were resistant to norfloxacin, 34(21.66%) were resistant to levofloxacin, 8(5.10%) were resistant to gatifloxacin, and 2(1.27%) were resistant to amikacin. No strains were resistant to meropenem or imipenem. Thirty-eight strains(36.89%) of Gram-positive bacteria were resistant to norfloxacin, 28(27.18%) were resistant to levofloxacin, 9(8.74%) were resistant to gatifloxacin, 15(14.56%) were resistant to roxithromycin, 12(11.65%) were resistant to azithromycin, 4(3.88%) were resistant to midecamycin, and 1 strain(0.97%) was resistant to vancomycin. No strains were resistant to teicoplanin. Of 41 strains of G. vaginalis, 18 formed a biofilm. Eleven strains of Gram-negative bacteria formed a biofilm, and they had a drug resistance of 61.11%(11/18); 5 strains of Gram-positive bacteria formed a biofilm, and they had a drug resistance of 26.09%(6/23). Gram-positive and Gram-negative bacteria differed significantly(χ~2=5.1034, P=0.02<0.05). Conclusion Escherichia coli was the main pathogen identified in this study, and macrolide antibiotics had a greater bacteriostatic effect. The susceptibility of G. vaginalis to antibiotics increased after it formed a biofilm.
Objectives To investigate the etiology of bacterial vaginosis(BV) and provide a strong basis for the prevention and treatment of BV. Methods Two hundred and twenty-six patients diagnosed with and treated for BV at this Hospital from January 2017 to December 2018 were retrospectively analyzed. Samples from patients with vaginitis were collected aseptically, and the bacteria were cultured and identified. The K-B disc method was used to test the susceptibility of pathogenic bacteria, and results were interpreted based on the 2017 guidelines of the CLSI. The formation of Gardnerella vaginalis biofilm was observed, and susceptibility to ciprofloxacin was tested. Results By age group, the 226 patients with BV consisted of 5 patients under the age of 20, 72 between the ages of 21 and 30, 83 between the ages of 31 and 40, 64 between the ages of 41 and 50, and 2 over the age of 51. By occupational, 71 patients were farmers, 53 were workers, 39 worked in the service industry, 28 were civil servants, 16 were teachers, 13 were public employees, and 6 were students. One hundred and ninety-two patients had a single infection and 34 had a double infection. Two hundred and sixty strains of pathogenic bacteria were cultured, including 157 strains of Gram-negative bacteria and 103 strains of Gram-positive bacteria. Thirty-eight strains(24.20%) of Gram-negative bacteria were resistant to ceftazidime, 37(23.57%) were resistant to cefepime, 50(31.85%) were resistant to norfloxacin, 34(21.66%) were resistant to levofloxacin, 8(5.10%) were resistant to gatifloxacin, and 2(1.27%) were resistant to amikacin. No strains were resistant to meropenem or imipenem. Thirty-eight strains(36.89%) of Gram-positive bacteria were resistant to norfloxacin, 28(27.18%) were resistant to levofloxacin, 9(8.74%) were resistant to gatifloxacin, 15(14.56%) were resistant to roxithromycin, 12(11.65%) were resistant to azithromycin, 4(3.88%) were resistant to midecamycin, and 1 strain(0.97%) was resistant to vancomycin. No strains were resistant to teicoplanin. Of 41 strains of G. vaginalis, 18 formed a biofilm. Eleven strains of Gram-negative bacteria formed a biofilm, and they had a drug resistance of 61.11%(11/18); 5 strains of Gram-positive bacteria formed a biofilm, and they had a drug resistance of 26.09%(6/23). Gram-positive and Gram-negative bacteria differed significantly(χ~2=5.1034, P=0.02<0.05). Conclusion Escherichia coli was the main pathogen identified in this study, and macrolide antibiotics had a greater bacteriostatic effect. The susceptibility of G. vaginalis to antibiotics increased after it formed a biofilm.
引文
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[4] 于浩,李连友,毛颖佳,等.泌尿科住院患者大肠埃希菌及尿肠球菌耐药基因检测与分析[J].中国病原生物学杂志,2018,13(7):770-3.
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[7] Mania PJ,Kerkar SC,Salvi VS.Bacterial vaginosis:a cause of infertility?[J].Int J STD AIDS,2009(20):778-81.
[8] Witkin SS,Linhares LM,Giraldo P.Bacterial flora of the female genital tract:function and immune regulation[J].Best Pract Res Clin Obstet Gvnaecol,2007,21(3):347-54.
[9] Lan PT Faxelid E Chuc NT et al.Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam:A qualitative study[J].Health Policy,2008(86):308-17.
[10] Vuotto C,Longo F,Donelli G.Probiotics to counteract biofilm-associated infections:promising and conflicting data[J].Intern J Oral Sci,2014,6(4):189-94.
[11] 贾天华,马秀凤,徐艳敏.已婚育龄妇女阴道炎患病调查[J].中国公共卫生,2012(12):1676.
[12] 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.
[13] Ma B,Forney LJ,Ravel J.Vaginal microbiome:rethingking health and disease[J].Annu Rev Microbiol,2012(66):371-89.
[14] 李盛,刘芳.300例孕妇阴道炎患者感染病原菌分布及耐药性分析[J].中国病原生物学杂志,2018,13(12):1401-4.
[15] 余竑敏.细菌性阴道病及其并发症的病原学调查和加德纳菌生物膜形成的研究[D].复旦大学,2013.
[2] Baisley K,Changalucha J,Weiss HA,et al.Bacterial vaginosis in femalefacility workers in north-western Tanzania:prevalence and risk factors[J].Sex Transm Infect,2009,85(5):370-5.
[3] Salah RM,Allam AM,Magdy AM,et al.Bacterial vaginosis and infertility:cause or association[J].Eur J Obstet Gynecol Reprod Biol,2013(167):59-63.
[4] 于浩,李连友,毛颖佳,等.泌尿科住院患者大肠埃希菌及尿肠球菌耐药基因检测与分析[J].中国病原生物学杂志,2018,13(7):770-3.
[5] Lamont RE.Recent evidence assoeiated with the condition of preterm prelabour rupture of the membranes[J].Curr Opin Obstet Gynecol,2003,15(2):91-9.
[6] Shujatullah F,Khan HM,Khatoon R,et al.An evaluation of OSOM BV blue test in the diagnosis of bacterial vaginosis [J].Asian Pacific J Tropi Med,2010,3(7):574-6.
[7] Mania PJ,Kerkar SC,Salvi VS.Bacterial vaginosis:a cause of infertility?[J].Int J STD AIDS,2009(20):778-81.
[8] Witkin SS,Linhares LM,Giraldo P.Bacterial flora of the female genital tract:function and immune regulation[J].Best Pract Res Clin Obstet Gvnaecol,2007,21(3):347-54.
[9] Lan PT Faxelid E Chuc NT et al.Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam:A qualitative study[J].Health Policy,2008(86):308-17.
[10] Vuotto C,Longo F,Donelli G.Probiotics to counteract biofilm-associated infections:promising and conflicting data[J].Intern J Oral Sci,2014,6(4):189-94.
[11] 贾天华,马秀凤,徐艳敏.已婚育龄妇女阴道炎患病调查[J].中国公共卫生,2012(12):1676.
[12] 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.
[13] Ma B,Forney LJ,Ravel J.Vaginal microbiome:rethingking health and disease[J].Annu Rev Microbiol,2012(66):371-89.
[14] 李盛,刘芳.300例孕妇阴道炎患者感染病原菌分布及耐药性分析[J].中国病原生物学杂志,2018,13(12):1401-4.
[15] 余竑敏.细菌性阴道病及其并发症的病原学调查和加德纳菌生物膜形成的研究[D].复旦大学,2013.