CAJ | 학술논문

目的：探讨哺乳期急性乳腺炎的致病菌种类及对抗菌药物的敏感情况，为临床合理选择抗菌药物提供依据。方法2012年1-8月在北京市海淀妇幼保健院乳腺病防治中心诊治的急性乳腺炎患者310例，对其433份标本（含患侧乳汁、穿刺液、脓肿破溃处分泌物）进行细菌培养和药敏试验，统计分析常见致病菌种类及其药敏特点。结果（1）433份标本中检出病原菌407株，包括金黄色葡萄球菌（SAU）215株，耐甲氧西林金黄色葡萄球菌（MRSA）43株，凝固酶阴性葡萄球菌43株，耐甲氧西林表皮葡萄球菌（MRSE）42株，表皮葡萄球菌（SE）22株，耐甲氧西林凝固酶阴性葡萄球菌（MRScon）12株，α-溶血链球菌8株等。（2）主要革兰阳性菌金黄色葡萄球菌、表皮葡萄球菌共237株，对其进行药敏试验，结果显示237株均对万古霉素敏感（100％），对青霉素（91.8％）、克林霉素（57.0％）、红霉素（69.0％）耐药率高，对左氧氟沙星（94.0％）、头孢类抗生素（70.0％）、庆大霉素（80.0％）敏感率高；耐甲氧西林金黄色葡萄球菌共43株，药敏试验显示对红霉素（13.0％）、克林霉素（15.0％）敏感率低，对青霉素、头孢类等β-内酰胺类抗生素100％耐药，对左氧氟沙星（95.0％）、庆大霉素（96.0％）、呋喃妥因（97.0％）、复方新诺明（92.0％）等敏感率高。结论哺乳期急性乳腺炎病原菌主要为金黄色葡萄球菌、耐甲氧西林金黄色葡萄球菌、凝固酶阴性葡萄球菌、耐甲氧西林表皮葡萄球菌、表皮葡萄球菌等革兰阳性球菌，对抗菌药物耐药率较高，尤其是对过去曾敏感的抗菌药物耐药率更高，应及时进行病原菌培养及药敏试验，为合理选择抗菌药物提供依据。
목적：탐토포유기급성유선염적치병균충류급대항균약물적민감정황，위림상합리선택항균약물제공의거。방법2012년1-8월재북경시해정부유보건원유선병방치중심진치적급성유선염환자310례，대기433빈표본（함환측유즙、천자액、농종파궤처분비물）진행세균배양화약민시험，통계분석상견치병균충류급기약민특점。결과（1）433빈표본중검출병원균407주，포괄금황색포도구균（SAU）215주，내갑양서림금황색포도구균（MRSA）43주，응고매음성포도구균43주，내갑양서림표피포도구균（MRSE）42주，표피포도구균（SE）22주，내갑양서림응고매음성포도구균（MRScon）12주，α-용혈련구균8주등。（2）주요혁란양성균금황색포도구균、표피포도구균공237주，대기진행약민시험，결과현시237주균대만고매소민감（100％），대청매소（91.8％）、극림매소（57.0％）、홍매소（69.0％）내약솔고，대좌양불사성（94.0％）、두포류항생소（70.0％）、경대매소（80.0％）민감솔고；내갑양서림금황색포도구균공43주，약민시험현시대홍매소（13.0％）、극림매소（15.0％）민감솔저，대청매소、두포류등β-내선알류항생소100％내약，대좌양불사성（95.0％）、경대매소（96.0％）、부남타인（97.0％）、복방신낙명（92.0％）등민감솔고。결론포유기급성유선염병원균주요위금황색포도구균、내갑양서림금황색포도구균、응고매음성포도구균、내갑양서림표피포도구균、표피포도구균등혁란양성구균，대항균약물내약솔교고，우기시대과거증민감적항균약물내약솔경고，응급시진행병원균배양급약민시험，위합리선택항균약물제공의거。
Objective To explore the pathogenic bacteria species of the patients with lactation acute mammitis and their sensitivities to antibiotics in order to provide a guideline in choosing antibiotics reasonably. Methods Four hundred and thirty-three samples from diseased breast(include milk,puncture fluid and secretion in ulcerateing skin)from 310 patients with lactation acute mammitis,who were treated by the center of mammary gland of Maternal and Child Health Care of Haidian district in BeiJing from Jan. to Aug. in 2012. Statistics analysis was made to analysis the pathogenic bacteria species and the characteristics of drug sensitivity. Results (1)Of the 433 samples,407 strains of pathogens were picked out,which consisted of 215 strains of Staphylococcus aureus(SAU),43 strains of methicillin-resistant staphylococcus aureus( MRSA),43 strains of coagulase negative staphylococcus(CNS),42 strains of Methicillin-resistant staphylococcus epidermis (MRSE),22 strains of Staphylococcus epidermidis(SE),12 strains of Methicillin-resistant coagulase negative staphylococci(MRScon)and 8 strains of Alpha hemolytic streptococcus.(2)There were 237 strains of G +bacteria,and the drug sensitive test showed that they were all sensitive to vancomycin(100% ),91. 8% were sensitive to penicillin,57. 0% to clindamycin( CLDM))and 69. 0% to erythrocin. Meanwhile,94. 0% were sensitive to levofloxacin,70. 0% to cephalosporins,and 80. 0% to gentamicin. In addition,there were 43 MRSA, and drug sensitivity test showed that 95. 0% were sensitive to levofloxacin,96. 0% to gentamicin,97. 0% to macrodantin,and 92. 0% to cotrimoxazole. Meanwhile,it's drug resistance rate to erythrocin was 13. 0% and 15. 0% to clindamycin( CLDM). MRSA was completely resistant to Lactam antibiotics( 100% ) such as penicillin and Cephalosporins,95. 0% to levofloxacin,96. 0% to gentamicin,97. 0% to furadantin and 92. 0% to bactrim. Conclusion The predominant pathogenic bacteria of lactation acute mammitis include SAU,MRSA, MRSA,CNS,MRSE,SE and they are all the G + bacteria. They are showed with a high rate of drug resistance, especially for the sensitive drugs which had been proved in the past. Due attention should be paid to germiculture from diseased breast and drug sensitive test as soon as possible,and to provide a guideline in choosing antibiotics reasonably.