精液细菌感染对精液参数及细菌耐药性的影响—附74376例男性不育症患者分析

目的男性不育症患者精液细菌感染对精液参数的影响和耐药分析。方法收集2016年4月~2017年4月在本院就诊的74376例男性不育患者的精液标本，按照细菌培养结果分为感染组和非感染组，比较两组不育症类型和精液参数的差异。对检出菌的种类进行统计，及药敏结果进行分析。结果精液细菌感染阳性率为1.38%，其中精液正常组阳性率为1.41%，弱精症组感染阳性率为1.55%，少精症感染阳性率为1.18%，少弱精症感染阳性率为1.57%，无精症感染阳性率为0.17%，无精症组阳性率低于其他组；细菌感染主要影响精子活力（P<0.05）、精子密度和前向精子比例（P<0.01）；细菌感染主要种类为：大肠埃希菌占63.59%，肺炎克雷伯菌肺炎亚种占19.80%和奇异变形杆菌占13.22%；药敏结果显示大肠埃希菌、肺炎克雷伯菌肺炎亚种、克氏柠檬酸杆菌对阿莫西林明显耐药，铜绿假单胞菌对复方新诺明、氨苄西林/舒巴坦明显耐药，金黄色葡萄球菌对青霉素明显耐药。结论不育患者精液细菌感染率较低，细菌感染对精子参与受精过程影响较大，可引起精子活力降低，密度减少。感染的细菌种类中大肠杆菌所占比例最高；除金黄色葡萄球菌之外，其他菌种对亚胺培南，美洛培南类药物敏感。

Effect of semen bacterial infection on semen parameters and analysis of drug resistancein 74376 male infertility patients

Objective To investigate the effect of semen bacterial infection on semen parameters in male infertility patients andanalyze of the drug resistance profile of the bacterial isolates. Methods According to the results of bacterial culture, the semensamples of 74376 infertile men collected between April, 2016 and April, 2017 were divided into infection group and noninfectiongroup, and the infertility type and semen parameters were compared between the two groups. The bacterial speciesand the drug sensitivity of the isolates were analyzed. Results Bacterial infections were detected in 1.38% of the total semensamples collected. The positivity rate of semen bacterial infection was 1.41% in normal semen group, 1.55% in asthenospermiagroup, 1.18% in oligospermia group, 1.57% in asthenospermia/ oligospermia group, and 0.17% in azoospermia group. Thepositivity rate was lower in azoospermia group than in the other groups. Bacterial infection mainly affected sperm motility (P<0.05), sperm density and forward motile sperm ratio (P<0.01). The most common bacterial species causing the infectionsincluded, in the descending order of frequencies, Escherichia coli (63.59%), Klebsiella pneumoniae subspecies (19.80%) and Proteusmirabilis (13.22%). Drug susceptibility tests showed that the isolates of Escherichiacoli, Pneumonia Klebsiella pneumonia subspeciesand Citrobacter koseri were commonly resistant to amoxicillin; Pseudomonas aeruginosa isolates were resistant to Bactrim andampicillin/sulbactam; Staphylococcus aureus isolates were resistant to penicillin. Conclusion Male infertile patients have a lowbacterial infection rate in the semen. Bacterial infection severely affects the sperm fertilization process by causing impairmentof sperm motility and lowered sperm density. Escherichia coli is the most common pathogenic bacterium for the semeninfection. With the exception of Staphylococcus aureus, the other bacterial strains isolated were found to be sensitive toimipenem and meropenem.