哺乳期乳腺脓肿病原菌分布及耐药情况

目的了解哺乳期乳腺脓肿患者病原菌分布及其耐药情况,以指导临床医生进行合理治疗。方法回顾性分析2015年1月—2016年12月某专科医院哺乳期乳腺脓肿患者脓液分离病原菌及其药敏结果。结果共收集142例哺乳期乳腺脓肿患者脓液标本,其中98份脓液标本分离病原菌99株,金黄色葡萄球菌94株(94/99,94.95%),耐甲氧西林金黄色葡萄球菌(MRSA)43株(43/94,45.74%),肺炎克雷伯菌2株,表皮葡萄球菌、粪肠球菌和彭氏变形杆菌各1株。金黄色葡萄球菌对青霉素耐药率高达90.43%,对红霉素、克林霉素、四环素耐药率分别为55.32%、39.36%和27.66%,对环丙沙星、莫匹罗星、复方磺胺甲口恶唑、阿米卡星耐药率相对较低,尚未发现耐万古霉素、夫西地酸、替考拉宁、奎奴普丁/达福普汀、利奈唑胺菌株;43株MRSA对红霉素、克林霉素、四环素耐药率分别为83.72%、72.09%和44.19%。结论引起哺乳期乳腺脓肿的病原菌主要为金黄色葡萄球菌,其对青霉素、红霉素、克林霉素和四环素耐药率相对较高,不应经验性选择上述药物治疗乳腺脓肿;同时,应警惕MRSA感染存在的可能,根据药敏结果合理选择抗菌药物,对暂停哺乳者进行母乳移除的指导。

Distribution and antimicrobial resistance of pathogens from patients with breast abscess during lactation

ObjectiveTo understand the distribution and antimicrobial resistance of pathogens from patients with breast abscess during lactation, so as to guide clinicians to make rational treatment.MethodsPathogens and antimicrobial susceptibility testing result of pathogens isolated from breast abscess of lactation patients in a specialty hospital from January 2015 to December 2016 were retrospectively analyzed.ResultsA total of 142 specimens from breast abscess were collected, 98 of which were isolated 99 strains of pathogens, there were 94 strains (94/99, 94.95%) of Staphylococcus aureus（S. aureus）, 43 (43/94, 45.74%) strains of methicillin resistant S. aureus (MRSA), 2 Klebsiella pneumoniae, 1 S. epidermidis, 1 Enterococcus faecalis, and 1 Proteus penneri. Resistance rate of S. aureus to penicillin was up to 90.43%, resistance rates to erythromycin, clindamycin, and tetracycline were 55.32%, 39.36%, and 27.66% respectively, to ciprofloxacin, mupirocin, compound sulfamethoxazole, and amikacin were relatively low, none strains were found to be resistant to vancomycin, fusidic acid, teicoplanin, quinupristin/dalfopristin, and linezolid; resistance rates of 43 strains of MRSA to erythromycin, clindamycin, and tetracycline were 83.72%, 72.09%, and 44.19% respectively.ConclusionThe main pathogens causing breast abscess during lactation are S. aureus, and its’ resistance rates to penicillin, erythromycin, clindamycin, and tetracycline are relatively high, these antimicrobial agents should not be empirically selected for the treatment of breast abscess. MRSA should be paid attention, antimicrobial agents should be chosen according to antimicrobial susceptibility testing result, patients who suspended breast feeding needs to be guided to remove breast milk.