高龄妇女剖宫产术后感染病原菌及耐药性趋势分析

目的 了解高龄产妇剖宫产术后感染的病原菌种类及耐药性趋势。方法 以3年为一时间段，对2007年1月-2015年12月进行剖宫产术后继发感染的高龄产妇的切口分泌物进行细菌培养和药敏试验。结果 2007-2009年、2010-2012年和2013-2015年分别分离出菌株77株、74株和75株，病原菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌和铜绿假单胞菌较为常见。细菌分布动态提示，革兰阳性菌感染呈逐渐下降趋势，而革兰阴性菌感染逐渐增加，其中以大肠埃希菌感染比例上升最为明显。药敏结果提示，革兰阳性菌对万古霉素、利福平耐药性较低，大肠埃希菌、铜绿假单胞菌等革兰阴性菌对亚胺培南、美罗培南、哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和阿米卡星等耐药性较低。耐药性动态提示，金黄色葡萄球菌对头孢曲松、左氧氟沙星的耐药性上升明显，大肠埃希菌对左氧氟沙星耐药性上升明显，铜绿假单胞菌对哌拉西林钠他唑巴坦钠和头孢他啶耐药性上升明显。结论 高龄产妇剖宫产术后感染以金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌和铜绿假单胞菌为主，革兰阳性菌感染呈逐渐下降趋势，而革兰阴性菌感染逐渐增加。药敏结果显示，致病菌对常用抗菌药物的多重耐药性严重，临床应合理使用抗菌药物。

Dynamic Analysis of Distribution and Antimicrobial Resistance of Cesarean Section Postoperative Infection of Elderly Maternal

OBJECTIVE To investigate the profile of distribution and antimicrobial resistance of cesarean section postoperative infection of elderly maternal. METHODS Three years as a time period, elderly maternal with cesarean section postoperative infection were enrolled in the study from January 2007 to December 2015 in our hospital, then the pus or secretions was sampled from the incision sites, the culture, isolation, and identification of the pathogenic bacteria were performed. RESULTS The 77 strains, 74 strains and 75 strains were isolated from 2007 to 2009, from 2010 to 2012 and from 2013 to 2015, respectively, most of them were Staphylococcus aureus, coagulase-negative Staphylococci, Escherichia coli and Pseudomonas aeruginosa. Dynamic analysis of bacteria distribution showed that infections caused by Gram-positive bacteria was gradually decreased, but Gram-negative bacterial infection was gradually increased. Among them, the proportion of Escherichia coli infection increased most significantly. Drug sensitivity results suggested that, drug resistance of Gram-positive bacteria on Vancomycin and Rifampicin were lower, and Gram-negative bacterial of Escherichia coli, Pseudomonas aeruginosa on Imipenem, Meropenem, Piperacillin tazobactam, Cefoperazone sulbactam and Amikacin were lower. Dynamic analysis of antimicrobial resistance showed that drug resistance of Staphylococcus aureus on ceftriaxone, levofloxacin, and Escherichia coli on levofloxacin, and Pseudomonas aeruginosa on Piperacillin tazobactam and Ceftazidime increased significantly. CONCLUSION Staphylococcus aureus, coagulase negative Staphylococci, Escherichia coli and Pseudomonas aeruginosa are the common pathogenic bacteria in cesarean section postoperative infection of elderly maternal, Gram-positive bacteria is gradually decreased, and Gram-negative bacterial infection is gradually increased. Drug sensitivity results show that the multi-drug resistance of pathogenic bacteria to common antibiotics is serious, and the antibiotics should be reasonably used.