哺乳期急性乳腺炎的致病菌分布及其药敏特点

目的：探讨哺乳期急性乳腺炎的致病菌种类及对抗菌药物的敏感情况，为临床合理选择抗菌药物提供依据。方法2012年1-8月在北京市海淀妇幼保健院乳腺病防治中心诊治的急性乳腺炎患者310例，对其433份标本（含患侧乳汁、穿刺液、脓肿破溃处分泌物）进行细菌培养和药敏试验，统计分析常见致病菌种类及其药敏特点。结果（1）433份标本中检出病原菌407株，包括金黄色葡萄球菌（SAU）215株，耐甲氧西林金黄色葡萄球菌（MRSA）43株，凝固酶阴性葡萄球菌43株，耐甲氧西林表皮葡萄球菌（MRSE）42株，表皮葡萄球菌（SE）22株，耐甲氧西林凝固酶阴性葡萄球菌（MRScon）12株，α-溶血链球菌8株等。（2）主要革兰阳性菌金黄色葡萄球菌、表皮葡萄球菌共237株，对其进行药敏试验，结果显示237株均对万古霉素敏感（100％），对青霉素（91.8％）、克林霉素（57.0％）、红霉素（69.0％）耐药率高，对左氧氟沙星（94.0％）、头孢类抗生素（70.0％）、庆大霉素（80.0％）敏感率高；耐甲氧西林金黄色葡萄球菌共43株，药敏试验显示对红霉素（13.0％）、克林霉素（15.0％）敏感率低，对青霉素、头孢类等β-内酰胺类抗生素100％耐药，对左氧氟沙星（95.0％）、庆大霉素（96.0％）、呋喃妥因（97.0％）、复方新诺明（92.0％）等敏感率高。结论哺乳期急性乳腺炎病原菌主要为金黄色葡萄球菌、耐甲氧西林金黄色葡萄球菌、凝固酶阴性葡萄球菌、耐甲氧西林表皮葡萄球菌、表皮葡萄球菌等革兰阳性球菌，对抗菌药物耐药率较高，尤其是对过去曾敏感的抗菌药物耐药率更高，应及时进行病原菌培养及药敏试验，为合理选择抗菌药物提供依据。

Pathogenic bacteria distribution and drug susceptibility characteristics of the patients with lactation acute mammitis

Objective To explore the pathogenic bacteria species of the patients with lactation acute mammitis and their sensitivities to antibiotics in order to provide a guideline in choosing antibiotics reasonably. Methods Four hundred and thirty-three samples from diseased breast（include milk,puncture fluid and secretion in ulcerateing skin）from 310 patients with lactation acute mammitis,who were treated by the center of mammary gland of Maternal and Child Health Care of Haidian district in BeiJing from Jan. to Aug. in 2012. Statistics analysis was made to analysis the pathogenic bacteria species and the characteristics of drug sensitivity. Results （1）Of the 433 samples,407 strains of pathogens were picked out,which consisted of 215 strains of Staphylococcus aureus（SAU）,43 strains of methicillin-resistant staphylococcus aureus（ MRSA）,43 strains of coagulase negative staphylococcus（CNS）,42 strains of Methicillin-resistant staphylococcus epidermis （MRSE）,22 strains of Staphylococcus epidermidis（SE）,12 strains of Methicillin-resistant coagulase negative staphylococci（MRScon）and 8 strains of Alpha hemolytic streptococcus.（2）There were 237 strains of G ＋bacteria,and the drug sensitive test showed that they were all sensitive to vancomycin（100% ）,91. 8% were sensitive to penicillin,57. 0% to clindamycin（ CLDM））and 69. 0% to erythrocin. Meanwhile,94. 0% were sensitive to levofloxacin,70. 0% to cephalosporins,and 80. 0% to gentamicin. In addition,there were 43 MRSA, and drug sensitivity test showed that 95. 0% were sensitive to levofloxacin,96. 0% to gentamicin,97. 0% to macrodantin,and 92. 0% to cotrimoxazole. Meanwhile,it＆#39;s drug resistance rate to erythrocin was 13. 0% and 15. 0% to clindamycin（ CLDM）. MRSA was completely resistant to Lactam antibiotics（ 100% ） such as penicillin and Cephalosporins,95. 0% to levofloxacin,96. 0% to gentamicin,97. 0% to furadantin and 92. 0% to bactrim. Conclusion The predominant pathogenic bacteria of lactation acute mammitis include SAU,MRSA,MRSA,CNS,MRSE,SE and they are all the G ＋ bacteria. They are showed with a high rate of drug resistance, especially for the sensitive drugs which had been proved in the past. Due attention should be paid to germiculture from diseased breast and drug sensitive test as soon as possible,and to provide a guideline in choosing antibiotics reasonably.