摘要
目的:探讨妇科门诊阴道分泌物感染的病原学分布以及耐药性,为临床治疗阴道炎提供依据和参考。方法:选取妇科门诊阴道炎患者678例,取阴道分泌物在显微镜下观察分泌物清洁度、是否存在线索细胞以及假丝酵母菌和滴虫,制作干片后通过革兰染色法判断是否存在革兰阴性双球菌。采用唾液酸酶法对细菌性阴道炎进行快速检测。对病原菌进行培养,并行药物耐药性检测。结果:678例患者中真菌感染最为常见,共237例,占34.96%,其中以白色假丝酵母菌感染为主,检出218例,占32.15;此外还有19例患者为光滑假丝酵母菌感染,占2.80%。细菌感染224例,占33.04%,其中以大肠埃希菌最为常见,检出79例,占11.65%,其次分别是无乳链球菌、粪肠球菌、肺炎克雷伯菌分别检出64例、56例和25例,分别占9.44%、8.26%和3.69%。支原体检出173例,占25.52%,其中解脲支原体96例(14.16%),人型支原体49例(7.23%),两种支原体合并感染28例(4.13%)。此外分别有19例(2.80%)、14例(2.06%)和11例(1.62%)患者分别感染衣原体、滴虫以及格兰阴性双球菌。白色假丝酵母就和光滑假丝酵母菌普遍对两性霉素B的耐药性较低,仅为0.84%,而对伊曲康唑和5-氟胞嘧啶的耐药性偏高,分别为11.81%和10.13%。革兰阳性菌对复方新诺明耐药性较高,达到55%,其次是氯霉素和氨苄西林,分别达到39.29%和23.21%;所有革兰阳性菌均不对替加环素和万古霉素耐药,此外对亚胺培南耐药性较低,仅为5.00%。革兰阴性菌普遍对氨苄西林、复方新诺明和头孢唑林耐药性较高,分别达到78.85%、63.46%和61.54%,而对亚胺培南的耐药性较低,仅为1.92%。支原体感染患者对环丙沙星、罗红霉素、阿奇霉素以及克拉霉素的耐药率较为接近,分别为50.29%、47.40%、41.04%和40.46%,而对司帕沙星的耐药率较低,仅为3.47%,其次是氧氟沙星,耐药率为21.97%。结论:引起女性阴道分泌物感染的病原学分布较为广泛,其中以真菌和细菌最为常见,其次是支原体。在临床治疗中应根据不同病原菌感染的特点,为患者选择耐药性较低的药物进行治疗,以期获得良好效果,缩短治疗时间,而且应夫妻同治,避免反复发作。
Objectives： To investigate the etiology distribution and drug resistance of vaginal secretions infection in gynecology clinic,to provide basis and reference for the clinical treatment of vaginitis. Methods： 678 patients with gynecological clinic vaginitis were selected as study subjects. Their vaginal discharge were observed under microscopes for cleanliness,as well as the presence or absence of clue cells of Candida and Trichomonas,and dry film was produced by Gram staining to determine whether there was leather Gram-negative meningitis. Sialidase was used for rapid detection of bacterial vaginosis. Pathogens were cultured for parallel detection of drug resistance. Results： Of the 678 patients,fungal infection was most common（ 237,34. 96%）,of which 218 cases were Candida albicans infection（ 32. 15%） and the rest 19 patients were C. glabrata infection（ 2. 80%）. 224 cases（ 33. 04%） were of bacterial infection,of which the most common was E. coli（ 79,11. 65%）,followed by Streptococcus agalactiae,Enterococcus faecalis,Klebsiella pneumoniae were detected in 64 cases,56 cases and 25 cases respectively,accounting for 9. 44%,8. 26% and 3. 69%. 173 cases（ 25. 52%） were of mycoplasma,of which UU in 96 cases（ 14. 16%）,Mycoplasma hominis in 49 cases（ 7. 23%）,two kinds of Mycoplasma coinfection in 28cases（ 4. 13%）. In addition there were 19 cases（ 2. 80%）,14 cases（ 2. 06%） and 11 cases（ 1. 62%） patients were infected with chlamydia,trichomoniasis and Grand-negative meningitis accordingly. In general,Candida albicans and C. glabrata had low resistance against amphotericin B of only 0. 84%,while high resistance against itraconazole and 5-fluorocytosine,11. 81% and 10. 13% respectively. Gram-positive bacteria was highly resistant a-gainst cotrimoxazole,reaching 55%,followed by chloramphenicol and ampicillin,39. 29% and 23. 21% respectively; all Gram-positive bacteria had no resistance against tigecycline and vancomycin hormone,while low resistance against imipenem,of only 5. 00%. Gram-negative bacteria exerted high resistance against ampicillin,cotrimoxazole and cefazolin,which were 78. 85%,63. 46% and 61. 54% respectively,while low resistance against imipenem of only 1. 92%. The resistance rate of patients with mycoplasma infection against ciprofloxacin,roxithromycin,azithromycin and clarithromycin were close,which were 50. 29%,47. 40%,41. 04% and 40. 46% respectively,while low resistance rate against sparfloxacin of only 3. 47%,followed by resistance rate against ofloxacin（ 21. 97%）. Conclusion： The etiology causes of vaginal infections are widely distributed,most common of fungi and bacteria,followed by mycoplasma. In the clinical treatment,drugs with lower resistance against should be selected based on the characteristics of the different pathogen infection,to obtain good results and shorten treatment time. Moreover,the couple should receive treatment together to avoid recurrence.
出处
《中国性科学》
2015年第2期3-6,共4页
Chinese Journal of Human Sexuality
关键词
妇科
分泌物
病原学检查
耐药性
Gynecology
Secretions
Pathologic examination
Drug resistance
