您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (1): 48-54.doi: 10.6040/j.issn.1671-7554.0.2021.0516

• 临床医学 • 上一篇    下一篇

50例孕产妇血流感染临床特征及胎盘病理分析

李燕1,刘静1,李娟2,杨秋红1   

  1. 济南市妇幼保健院 1.妇产科;2.病理科, 山东 济南 250001
  • 发布日期:2022-01-08
  • 通讯作者: 杨秋红. E-mail:yqh18053153320@126.com
  • 基金资助:
    山东省济南市科技计划项目(201907016)

Clinical characteristics and placental pathology of bloodstream infection in 50 pregnant women

LI Yan1, LIU Jing1, LI Juan2, YANG Qiuhong1   

  1. 1. Department of Obstetrics and Gynecology;
    2. Department of Pathology, Jinan Maternity and Child Care Hospital, Jinan 250001, Shandong, China
  • Published:2022-01-08

PDF (PC)

256

摘要： 目的 探讨孕产妇血流感染的临床特征及胎盘病理分析。 方法 选取2016年8月1日至2020年8月1日济南市妇幼保健院妇产科病房收治的50例血流感染孕产妇作为研究组(血流感染组),50例非血流感染孕产妇作为对照组(非血流感染组),分析两组患者年龄、分娩方式、感染时间、特殊级别抗生素应用、胎儿窘迫、死胎、流产、早产、新生儿感染、孕产妇感染性休克、孕产妇死亡、胎盘母体炎症反应、胎盘胎儿炎症反应等指标的异同。收集血流感染组血培养分离出的病原菌资料,分析病原菌分布,并对检出率最高的病原菌做药敏结果分析。 结果 血流感染组使用特殊级别抗生素比例高于非血流感染组,差异有统计学意义(P<0.001)。血流感染组发生孕产妇感染性休克(P=0.041)、早产(P=0.007)、流产(P=0.012)、死胎(P=0.041)、新生儿感染(P=0.022)、胎盘母体炎症反应(P=0.006)、胎盘胎儿炎症反应(P=0.003)的概率高于非血流感染组,差异有统计学意义。孕产妇血流感染前6位致病菌分别为:大肠埃希菌(50%)、李斯特菌(10%)、粪肠球菌(8%)、化脓链球菌(6%)、无乳链球菌(4%)、金黄色葡萄球菌(4%)。大肠埃希菌对头孢西丁、头孢他啶、妥布霉素、氨苄西林/舒巴坦有较高的敏感率(≥80%);对美罗培南、亚胺培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、替卡西林/克拉维酸的敏感率均超过95%。 结论 孕产妇血流感染严重威胁母儿生命健康,其中大肠埃希菌感染率最高,但对母儿危害严重的化脓性链球菌、李斯特菌亦应引起重视。对发热的妊娠女性尽早行规范的血培养,针对性选择敏感抗生素,可改善母儿预后,降低母儿死亡率。

关键词: 血流感染, 妊娠, 病原菌, 耐药性, 胎盘病理

Abstract: Objective To analyze the clinical characteristics and placental pathology of bloodstream infection in pregnant women. Methods A total of 50 pregnant women with bloodstream infection during Aug. 1, 2016 and Aug. 1, 2020 were selected as the bloodstream infection group, and another 50 pregnant women without blood stream infection were selected as the control group. The age, delivery mode, infection time, application of special antibiotics, fetal distress, stillbirth, abortion, premature delivery, neonatal infection, septic shock, maternal death, placenta maternal inflammatory reaction, placenta fetal inflammatory reaction and other indicators were analyzed. The pathogenic bacteria isolated from blood culture in the bloodstream infection group were collected, the distribution of pathogenic bacteria was analyzed, and the drug sensitivity results of the pathogenic bacteria with the highest detection rate were analyzed. Results The use of special antibiotics in the bloodstream infection group was higher than that in the control group(P<0.001). The bloodstream infection group had higher probability of septic shock(P=0.041), premature delivery(P=0.007), abortion(P=0.012), stillbirth(P=0.041), neonatal infection(P=0.022), placental maternal inflammation(P=0.006)and placental fetal inflammation(P=0.003)than the control group. The top 6 pathogenic bacteria were Escherichia coli(50%), Listeria(10%), Enterococcus faecalis(8%), Streptococcus pyogenes(6%), Streptococcus agalactiae(4%), Staphylococcus aureus(4%). Escherichia coli was sensitive to cefoxitin, ceftazidime, tobramycin, and ampicillin/sulbactam(≥80%). The sensitivity rates to meropenem, imipenem, amikacin, cefoperazone/sulbactam, piperacillin/tazobactam and ticacillin/clavulanate were over 95%. Conclusion Bloodstream infection seriously threatens the life and health of mothers and children. Escherichia coli has the highest infection rate, and Streptococcus pyogenes and Listeria also have serious harm to mothers and children. For pregnant women with fever, early standardized blood culture and targeted selection of sensitive antibiotics can improve the prognosis and reduce the mortality of mothers and children.

Key words: Bloodstream infection, Pregnancy, Pathogens, Drug resistance, Placental pathology

中图分类号: 

  • R714.7
[1] Lucas DN, Robinson PN, Nel MR. Sepsis in obstetrics and the role of the anaesthetist [J]. Int J Obstet Anesth, 2012, 21(1): 56-67.
[2] 刘平, 樊尚荣, 梁轶珩, 等. 41例妊娠期和产后脓毒症病例分析[J]. 中华产科急救电子杂志, 2018, 7(3): 174-179. LIU Ping, FAN Shangrong, LIANG Yiheng, et al. Analysis of 41 cases of sepsis during pregnancy and postpartum [J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2018, 7(3): 174-179.
[3] 凌利芬, 陆学东, 汤一苇. 血流感染的实验室诊断进展研究[J]. 中华医院感染学杂志, 2018, 28(14): 2234-2240. LING Lifen, LU Xuedong, TANG Yiwei. Advances in laboratory diagnosis of bloodstream infections [J]. Chinese Journal of Nosocomiology, 2018, 28(14): 2234-2240.
[4] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.
[5] 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018:70-140.
[6] Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions: amsterdam placental workshop group consensus statement [J]. Arch Pathol Lab Med, 2016, 140(7): 698-713.
[7] Burlinson CEG, Sirounis D, Walley KR, et al. Sepsis in pregnancy and the puerperium [J]. Int J Obstet Anesth, 2018, 36: 96-107. doi: 10.1016/j.ijoa.2018.04.010.
[8] Hensley MK, Bauer ME, Admon LK, et al. Incidence of maternal sepsis and sepsis-related maternal deaths in the United States [J]. JAMA,2019, 322(9): 890-892.
[9] Acosta CD, Knight M. Sepsis and maternal mortality [J]. Curr Opin Obstet Gynecol, 2013, 25(2): 109-116.
[10] 钟旋, 张温魔, 蔡双明. A组链球菌感染引起的中毒性休克综合征合并妊娠1例[J]. 广东医学, 2019, 40(23): 3361-3362. ZHONG Xuan, ZHANG Wenmo, CAI Shuangming. Toxic shock syndrome complicated with pregnancy caused by group A streptococcus infection: a case report [J]. Guangdong Medical Journal, 2019, 40(23): 3361-3362.
[11] 杨秋红, 宋敏, 孙谦, 等. 妊娠晚期链球菌中毒性休克综合征2例报道及文献复习[J]. 中华围产医学杂志, 2019, 22(12): 872-877. YANG Qiuhong, SONG Min, SUN Qian, et al. Streptococcal toxic shock syndrome in third trimester: a report of two cases and literature review [J]. Chinese Journal of Perinatal Medicine, 2019, 22(12): 872-877.
[12] 韩彤妍, 杨孜, 朴梅花. 绒毛膜羊膜炎与胎儿及新生儿疾病[J]. 中国实用妇科与产科杂志, 2016, 32(6): 529-534. HAN Tongyan, YANG Zi, PIAO Meihua. Chorioamnionitis and fetal and neonatal diseases [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2016, 32(6): 529-534.
[13] 吴婷, 颜伟卉, 罗力冰, 等. 国内102例妊娠合并李斯特菌感染的临床分析[J]. 临床医药文献电子杂志, 2020, 7(52): 9-11. WU Ting, YAN Weihui, LUO Libing, et al. Clinical analysis of 102 cases of pregnancy complicated with listeria infection in China [J]. Journal of Clinical Medical Literature(Electronic Edition), 2020, 7(52): 9-11.
[14] 宋敏, 牟瑞丽, 张琳琳, 等. 妊娠合并单核李斯特菌感染7例临床分析[J]. 现代妇产科进展, 2021, 30(3): 200-203. SONG Min, MU Ruili, ZHANG Linlin, et al. A clinical analysis of 7 patients with maternal listeriosis [J]. Progress in Obstetrics and Gynecology, 2021, 30(3): 200-203.
[15] 冯轶, 周莉. 妊娠期李斯特菌感染的临床分析[J]. 北京医学, 2020, 42(12): 1249-1251. FENG Yi, ZHOU Li. Clinical analysis of listeria infection during pregnancy [J]. Beijing Medical Journal, 2020, 42(12): 1249-1251.
[16] 胡付品, 朱德妹, 汪复, 等. 2014年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2015(5): 401-410. HU Fupin, ZHU Demei, WANG Fu, et al. CHINET 2014 surveillance of bacterial resistance in China [J]. Chinese Journal of Infection and Chemotherapy, 2015(5): 401-410.
[17] 全国细菌耐药监测网. 全国细菌耐药监测网2014-2019年血标本病原菌耐药性变迁[J]. 中国感染控制杂志, 2021, 20(2): 124-133. China Antimicrobial Resistance Surveillance System. Change in antimicrobial resistance of pathogens from blood specimens: surveillance report from China Antimicrobial Resistance Surveillance System in 2014-2019 [J]. Chinese Journal of Infection Control, 2021, 20(2): 124-133.
[18] 周翠香, 折瑞莲, 张杰生, 等. 妊娠期及产褥期脓毒症的临床特点分析[J]. 中国临床研究, 2020, 33(9): 1235-1238. ZHOU Cuixiang, ZHE Ruilian, ZHANG Jiesheng, et al. Clinical characteristics of sepsis in pregnancy and puerperium [J]. Chinese Journal of Clinical Research, 2020, 33(9): 1235-1238.
[19] 马成云, 李波, 李文君, 等. 医院感染的预防和控制[J]. 中华医院感染学杂志, 2005, 15(5): 550-552. MA Chengyun, LI Bo, LI Wenjun, et al. Prevention and control of nosocomial infection [J]. Chinese Journal of Nosocomiology, 2005, 15(5): 550-552.
[20] 周先荣. 胎盘病理学检查的意义和基本原则[J]. 中华病理学杂志, 2020, 49(8): 779-781. ZHOU Xianrong. The significance and essential principles of placental pathology [J]. Chinese Journal of Pathology, 2020, 49(8): 779-781.
[21] Hockney R, Waring GJ, Taylor G, et al. Fetal membrane bacterial load is increased in histologically confirmed inflammatory chorioamnionitis: a retrospective cohort study [J]. Placenta, 2020, 91: 43-51. doi: 10.1016/j.placenta.2020.01.006.
[22] Kim CJ, Romero R, Chaemsaithong P, et al. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance [J]. Am J Obstet Gynecol, 2015, 213(4 Suppl): S29-S52.
[23] Rovira N, Alarcon A, Iriondo M, et al. Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants [J]. Early Hum Dev, 2011, 87(4): 253-257.
[24] 李娟, 尹燕雪, 赵澄泉, 等. 胎盘炎性病变的分类、病理特征及临床意义[J]. 中华病理学杂志, 2021, 50(3): 300-304. LI Juan, YIN Yanxue, ZHAO Chengquan, et al. Classification, pathological features and clinical significance of placental inflammatory lesions [J]. Chinese Journal of Pathology, 2021, 50(3): 300-304.
[25] 旷凌寒, 龚云辉, 苏敏, 等. 妊娠期李斯特菌病19例临床分析[J]. 中华妇产科杂志, 2017, 52(10): 657-661. KUANG Linghan, GONG Yunhui, SU Min, et al. Clinical analysis of 19 pregnancies complicated listeriosis [J]. Chinese Journal of Obstetrics and Gynecology, 2017, 52(10): 657-661.
[1] 艾星子·艾里,郭铮宇,张晓霏. 子宫腺肌病高强度聚焦超声消融治疗研究进展[J]. 山东大学学报 (医学版), 2022, 60(7): 36-42.
[2] 曹丹凤,刘宗花,王君芝,张国翔. 女性儿童期家庭功能障碍对成年后妊娠期抑郁症状的独立和累积作用[J]. 山东大学学报 (医学版), 2022, 60(6): 97-101.
[3] 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39.
[4] 鞠建华,杨镇业,李青连,韩亚楠,李艳青,乔伊君,杨虎,张华然. 微生物药物研究开发现状与思考[J]. 山东大学学报 (医学版), 2021, 59(9): 43-50.
[5] 张建平,罗莺儿. 抗凝药物在反复不良妊娠治疗中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 14-19.
[6] 陈伟,郭情情,徐金,方园,孙梅,盛燕. 自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析[J]. 山东大学学报 (医学版), 2021, 59(8): 61-66.
[7] 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.
[8] 龙宇晗,罗霞,姜洁. 妊娠期异常高脂血症2例报告并文献复习[J]. 山东大学学报 (医学版), 2021, 59(3): 103-106.
[9] 萧阳,陶宇,王方怡,梁俞秀,张晋,季晓康,王志萍. 山东省部分地区PM2.5和PM10暴露与妊娠期糖尿病的关联性分析[J]. 山东大学学报 (医学版), 2021, 59(12): 101-109.
[10] 霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.
[11] 赵立红,赵书平,聂升刚,孙晶,姜同峰. 507例男性生殖道感染病原体分布及耐药特征[J]. 山东大学学报 (医学版), 2021, 59(1): 55-58.
[12] 陈擎仪,张烜,王娟,孙继伟,曹丹凤, 曹枫林. 妊娠期女性自杀意念的危险因素及其累积效应[J]. 山东大学学报 (医学版), 2021, 59(1): 91-94.
[13] 贾明旺,廖广园,熊明媚,徐文婷,王银玲,王懿春. 84例妊娠合并肺高血压患者预后的临床分析[J]. 山东大学学报 (医学版), 2021, 59(1): 34-39.
[14] 师少乐,宫伟雁. 妊娠相关噬血细胞性淋巴组织细胞增多症1例[J]. 山东大学学报 (医学版), 2020, 58(6): 121-124.
[15] 张秀清,张敬,蒋琪,李晨,刘畅,李瑞静,冯惠娟,耿玲. 腔内理疗对89例薄型子宫内膜冻融胚胎移植患者妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(5): 62-68.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 方英立,马玉燕,刘锡梅,周文 . 急诊剖宫产患者围手术期替硝唑合理应用[J]. 山东大学学报(医学版), 2007, 45(10): 995 .
[2] 姜红菊,李润智,王营,徐冬梅,张梅,张运,李继福 . 冠状动脉粥样硬化斑块形态及介入治疗与MMP-9的关系[J]. 山东大学学报(医学版), 2008, 46(10): 966 -970 .
[3] 郑敏,郝跃伟,刘雪平,赵婷婷. 血小板膜糖蛋白Ibα基因HPA-2、Kozak序列多态性与脑梗死的相关性研究[J]. 山东大学学报(医学版), 2008, 46(3): 292 -295 .
[4] 王术芹,齐 峰,吴剑波,孙宝柱. 罗哌卡因对大鼠离体主动脉收缩作用的钙离子调节机制[J]. 山东大学学报(医学版), 2008, 46(8): 773 -776 .
[5] 滕学仁,赵永生,胡光亮,周伦,李建民 . 两种方法保存同种异体髌腱移植重建膝关节交叉韧带的光镜电镜观察[J]. 山东大学学报(医学版), 2008, 46(10): 945 -950 .
[6] 赵鹏,毕万利,李宁 . 螺旋CT后处理技术对青少年先天性脊柱畸形的诊断价值[J]. 山东大学学报(医学版), 2007, 45(8): 825 -829 .
[7] 袁吴敏,赵志伦,王洁贞 . 吸烟和饮酒与颅内肿瘤关系的Meta分析[J]. 山东大学学报(医学版), 2006, 44(11): 1146 -1149 .
[8] 杨希1 ，高鹏2 ，薛玉文1 ，王妍2 ，刘文君2 ，张晓芳2
. 肺腺癌中DNA甲基转移酶1的表达[J]. 山东大学学报(医学版), 2009, 47(01): 30 -33 .
[9] 张杰,李振华,孙晋浩,暴丽华,刘岳鹏. 恒定磁场对Schwann细胞氧化损伤的保护作用[J]. 山东大学学报(医学版), 2007, 45(3): 229 -232 .
[10] 焦芳芳,刘世青,李飞,李长生,王琴,孙青,鹿伟 . 化瘀理肺方对大鼠肺间质纤维化时Smad7和TGF-β表达的影响[J]. 山东大学学报(医学版), 2007, 45(10): 1054 -1058 .
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发