50例孕产妇血流感染临床特征及胎盘病理分析

doi:10.6040/j.issn.1671-7554.0.2021.0516

摘要/Abstract

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

李燕,刘静,李娟,杨秋红. 50例孕产妇血流感染临床特征及胎盘病理分析[J]. 山东大学学报 (医学版), 2022, 60(1): 48-54.

LI Yan, LIU Jing, LI Juan, YANG Qiuhong. Clinical characteristics and placental pathology of bloodstream infection in 50 pregnant women[J]. Journal of Shandong University (Health Sciences), 2022, 60(1): 48-54.

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