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目的探讨绒毛膜羊膜炎感染的发病特点、致病菌及耐药情况。方法回顾性分析自2007年1月至2015年2月在海淀区妇幼保健院产科住院分娩、诊断为绒毛膜羊膜炎、行宫腔细菌培养和药敏试验阳性的78例患者的临床资料。并将其分为敏感组(53例)和耐药组(25例),比较两组患者的体温、血白细胞、中性粒细胞、C反应蛋白恢复时间。结果 78例绒毛膜羊膜炎患者中,主要致病菌为大肠埃希菌(23.8%)、B族链球菌(22.5%)、金黄色葡萄球菌(15.0%)和粪肠球菌(15.0%)。药敏结果显示,青霉素类耐药率56.5%(105/186),头孢类耐药率24.2%(44/182);喹诺酮类耐药率32.0%(39/122),氨基糖甙类耐药率29.8%(37/124)。敏感组体温恢复正常时间[(2.9±1.5)d]较耐药组[(4.2±1.8)d]更短(P=0.034),两组血白细胞、中性粒细胞和C反应蛋白恢复时间比较,差异无统计学意义(P=0.516)。78例患者均应用广谱抗生素,新生儿感染19例(24.4%),产褥感染11例(14.1%)。两组产褥感染和新生儿感染率比较,差异均无统计学意义(P=0.304、0.607)。结论绒毛膜羊膜炎常见致病菌为大肠埃希菌和B族链球菌,应选择广谱抗生素进行治疗,应用致病菌敏感的抗生素体温恢复正常时间更短。
Objective To investigate the incidence of chorioamnionitis infection, pathogens and drug resistance. Methods The clinical data of 78 patients who were admitted to obstetrics and gynecology hospital of Haidian MCH from January 2007 to February 2015 were retrospectively analyzed. The clinical data of 78 patients diagnosed as chorioamnionitis, uterine cavity bacterial culture and drug susceptibility test were retrospectively analyzed. The patients were divided into sensitive group (53 cases) and drug resistant group (25 cases). The body temperature, blood leukocytes, neutrophils and C-reactive protein recovery time were compared between the two groups. Results Among 78 chorioamnionitis patients, the main pathogenic bacteria were Escherichia coli (23.8%), Streptococcus group B (22.5%), Staphylococcus aureus (15.0%) and Enterococcus faecalis (15.0%). The susceptibility results showed that the resistance rate of penicillin was 56.5% (105/186), that of cephalosporins was 24.2% (44/182), that of quinolones was 32.0% (39/122), aminoglycoside resistance The rate was 29.8% (37/124). Compared with the drug-resistant group [(4.2 ± 1.8) d], the recovery time of body temperature in the sensitive group was shorter than that in the drug-resistant group (2.9 ± 1.5 d) (P = 0.034). The recovery time of leukocyte, neutrophil and C-reactive protein , The difference was not statistically significant (P = 0.516). In the 78 patients, broad-spectrum antibiotics were used. Neonatal infection was found in 19 cases (24.4%) and puerperal infection in 11 cases (14.1%). There was no significant difference in the rates of puerperal infection and neonatal infection between the two groups (P = 0.304,0.607). Conclusion The common pathogens of chorioamnionitis are Escherichia coli and Streptococcus group B, and broad-spectrum antibiotics should be selected for treatment. The use of antibiotics that are sensitive to pathogenic bacteria to restore normal body temperature is shorter.