妊娠合并糖尿病对产妇剖宫产后产褥期感染病原菌特点及耐药性的影响

Effect of gestational diabetes mellitus on the characteristics and drug resistance of pathogenic bacteria in puerperium infection after cesarean section

摘要:

目的 探讨妊娠合并糖尿病对产妇剖宫产后产褥期感染病原菌特点及耐药性的影响。方法 回顾性分析2018年5月—2021年7月贵阳市妇幼保健院79例剖宫产后产褥期感染患者的临床资料，根据妊娠期是否合并糖尿病分为研究组47例（妊娠合并糖尿病）和对照组32例（妊娠未合并糖尿病）。比较两组患者的一般资料、不同感染部位病原菌特点、产褥期感染病原菌分布情况、产褥期感染的主要革兰阳性菌（金黄色葡萄球菌、表皮葡萄糖菌）和主要革兰阴性菌（大肠埃希菌、铜绿假单胞菌）对常见抗菌药物的耐药性。结果 两组孕周、喂养方式、感染部位、年龄、产程比较，差异无统计学意义（P >0.05）；79例剖宫产后产褥期感染患者中共分离检出94株菌株（对照组41株、研究组53株），两组病原菌感染部位比较，差异无统计学意义（P >0.05）；94株菌株中革兰阳性菌50株（53.19%），革兰阴性菌32株（34.04%），真菌12株（12.77%），两组产褥期感染的革兰阳性菌、真菌数比较，差异无统计学意义（P >0.05），研究组产褥期感染的革兰阴性菌多于对照组（P <0.05）；研究组产褥期感染的革兰阴性菌中大肠埃希菌多于对照组（P <0.05）；两组产褥期感染的金黄色葡萄球菌对氨苄青霉素、氧氟沙星、头孢拉定、环丙沙星的耐药性均>50%，研究组产褥期感染的金黄色葡萄球菌对头孢噻肟的耐药性高于对照组（P <0.05）；两组产褥期感染的大肠埃希菌对氨苄青霉素、头孢他啶、庆大霉素的耐药性均>50%，研究组产褥期感染的铜绿假单胞菌对哌拉西林/他唑巴坦、亚胺培南的耐药性高于对照组（P <0.05）。结论 妊娠合并糖尿病对产妇剖宫产后产褥期感染病原菌特点及耐药性具有一定的影响，其可增加革兰阴性感染率，也可提高金黄色葡萄球菌与铜绿假单胞菌的耐药性。

Abstract:

Objective To investigate the effect of gestational diabetes mellitus on the characteristics and drug resistance of pathogenic bacteria in puerperium infection after cesarean section.Methods The clinical data of 79 patients with puerperal infection after cesarean section who were admitted to the hospital from May 2018 to July 2021 were retrospectively analyzed. According to the presence of diabetes during pregnancy, they were divided into a study group (gestational diabetes mellitus, n = 47) and a control group (pregnancy without diabetes mellitus, n = 32). The general data of the two groups of patients were compared. The characteristics of pathogenic bacteria at different infection sites in the two groups were compared. The distribution of pathogenic bacteria during puerperium between the two groups was compared. The resistance of two groups of puerperal infections to the main gram-positive bacteria (Staphylococcus aureus and Gluconobacter epidermidis) to common antibiotics was compared. The drug resistance of the main gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) infected in the puerperium to common antibiotics was compared between the two groups.Results There was no significant difference in gestational age, feeding method, infection site, age, and labor process between the two groups (P >0.05). A total of 94 strains were isolated from the specimens of 79 patients with puerperal infection after cesarean section, 41 strains were isolated and detected in the control group, and 53 strains were isolated and detected in the research group. There was no significant difference in the infection site of pathogenic bacteria between the two groups (P > 0.05). Among the 94 strains, 50 strains of Gram-positive bacteria (53.19%), 32 strains of Gram-negative bacteria (34.04%), and 12 strains of fungi (12.77%). There was no significant difference in the proportion of Gram-positive bacteria and fungi in puerperium infection between the two groups (P > 0.05). The proportion of Gram-negative bacteria cases in the puerperium infection in the study group was higher than that in the control group (P < 0.05). The proportion of Escherichia coli in Gram-negative bacteria infected during puerperium in the study group was higher than that in the control group (P <0.05). The resistance to ampicillin, ofloxacin, cefradine, and ciprofloxacin in the main gram-positive bacteria infected in the puerperium in the two groups were all over 50%. The resistance to cefotaxime of Staphylococcus aureus infected during puerperium in the study group was higher than that in the control group (P < 0.05). The resistance to ampicillin, ceftazidime, and gentamicin of the main gram-negative bacteria infected in the puerperium in the two groups were all over 50%. The resistance of Pseudomonas aeruginosa infected during puerperium to piperacillin / tazobactam and imipenem in the study group was higher than that in the control group (P < 0.05).Conclusion Gestational diabetes mellitus has a certain influence on the characteristics and drug resistance of pathogenic bacteria in puerperium infection after cesarean section, which can increase the Gram-negative infection rate, and can improve the drug resistance of Pseudomonas aeruginosa and Staphylococcus aureus.