引起化脓性脓毒症产后并发症的病原微生物群特征:一项回顾性队列研究

O. V. Lazareva, S. V. Barinov, E. Shifman, L. D. Popova, L. L. Shkabarnya, Y. Tirskaya, T. V. Kadtsyna, Yu.I. Chulovsky
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The study included 123 cesarean section patients treated from January 2013 to December 2022 who were divided into three groups: Group A — uncomplicated course of postpartum endometritis, n = 55; Group B — complicated forms of postpartum endometritis, n = 48: B1 — local complications (suture failure following cesarean section; parametritis) n = 29; B2 — pelvic peritonitis, n = 19; Group C — septic complications following critical obstetric conditions, n = 20. The pathogenic microflora of uterine and abdominal cavities was examined; the extent of contamination with a pathogen and sensitivity to antibacterial drugs were determined. The isolated microorganisms were identified using a MicroTax bacteriological analyzer (Austria), Vitek2 Compact (France) and routine methods; a disk diffusion method was employed to determine the sensitivity of microorganisms to antibacterial drugs. Calculations were performed using licensed Microsoft Office Excel 2013 and Statistica 10 programs (StatSoft Inc., USA). Nonparametric nominal data were compared using Pearson’s chi-squared test with p-value determination.Results. The pathogenic microflora was dominated by S. epidermidis, E. faecalis, E. coli, and E. faecium. In 2018–2022, a statistically significant decrease was observed in the isolation rate of S. epidermidis (p = 0.016), E. faecalis (p < 0.001), and E. faecium (p = 0.05). The highest resistance was exhibited by bacteria to the following antibiotics: S. epidermidis — cephalosporins (30.16%); E. faecalis — fluoroquinolones (33.33%); E. coli — cephalosporins (65.91%) and β-lactamase-resistant penicillins (40.91%); E. faecium — aminopenicillins (64.10%) and fluoroquinolones (50.0%); А. baumannii — fluoroquinolones, cephalosporins, carbapenems (100%), and aminoglycosides (84.2%). A contamination assessment revealed a high titer of isolated microorganisms in 60.53% of cases. We found a statistically significantly higher isolation rate of S. еpidermidis (p < 0.001), E. faecium (p = 0.01), and A. baumannii (p = 0.02) in the setting of pelvic peritonitis as compared to uncomplicated endometritis. In the case of suppurative septic complications due to critical obstetric conditions, the isolation rate was higher for S. еpidermidis (p <0.001), E. coli (p = 0.04), E. faecium (p = 0.005), A. baumannii (р<0.001), and K. рneumoniae (p = 0.04).Conclusion. 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引用次数: 0

摘要

背景假定性脓毒症产后并发症在孕产妇死亡率结构中占据主导地位。关于各种形式并发症中病原菌群特征的信息以及对抗菌药物耐药性的分析决定了对这种病理的合理治疗选择。目的:了解产科化脓性脓毒症产后并发症患者分离的病原菌群特征。方法。在鄂木斯克国立医科大学2号妇产科和鄂木斯克地区临床医院妇科进行了一项回顾性队列研究。该研究包括2013年1月至2022年12月接受治疗的123名剖宫产患者,他们被分为三组:A组——产后子宫内膜炎的无并发症病程,n=55;B组——产后子宫内膜炎的复杂形式,n=48:B1——局部并发症(剖宫产术后缝合失败;子宫旁炎)n=29;B2——盆腔腹膜炎,n=19;C组——产科危重症后的败血症并发症,n=20。检查子宫和腹腔的病原菌群;测定了病原体的污染程度和对抗菌药物的敏感性。使用MicroTax细菌分析仪(奥地利)、Vitek2 Compact(法国)和常规方法鉴定分离的微生物;采用圆盘扩散法测定微生物对抗菌药物的敏感性。使用授权的Microsoft Office Excel 2013和Statistica 10程序(美国股份有限公司StatSoft)进行计算。使用Pearson卡方检验和p值测定对非参数标称数据进行比较。后果病原菌群以表皮葡萄球菌、粪大肠杆菌、大肠杆菌和粪大肠杆菌为主。2018-2022年,表皮葡萄球菌(p=0.016)、粪肠球菌(p<0.001)和粪肠球菌(p=0.05)的分离率在统计学上显著下降。细菌对以下抗生素表现出最高的耐药性:表皮葡萄球菌-头孢菌素(30.16%);粪大肠杆菌-氟喹诺酮类(33.33%);大肠杆菌-头孢菌素类(65.91%)和耐β-内酰胺酶青霉素类(40.91%);粪大肠杆菌-氨基青霉素类(64.10%)和氟喹诺酮类(50.0%);А。鲍曼菌-氟喹诺酮类、头孢菌素类、碳青霉烯类(100%)和氨基糖苷类(84.2%)。污染评估显示,60.53%的病例中分离出的微生物滴度很高。我们发现,与无并发症的子宫内膜炎相比,在盆腔腹膜炎中,皮氏葡萄球菌(p<0.001)、粪大肠杆菌(p=0.01)和鲍曼不动杆菌(p<0.02)的分离率在统计学上显著较高。在因产科危重而出现化脓性脓毒症并发症的情况下,皮氏假单胞菌(p<0.001)、大肠杆菌(p=0.04)、粪大肠杆菌(p=0.005)、鲍曼不动杆菌(р<0.001)的分离率更高,病原微生物的抗生素耐药性要求开发新的器官系统支持技术,并使用能够在炎症领域吸收微生物及其毒素的方法。
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Characterization of Pathogenic Microflora Causing Suppurative Septic Postpartum Complications: a Retrospective Cohort Study
Background. Suppurative septic postpartum complications occupy a leading position in the structure of causes of maternal mortality. Information about the characteristics of pathogenic microflora in various forms of complications and analysis of its resistance to antibacterial drugs determine the choice of rational therapy for this pathology.Objectives — to characterize the isolated pathogenic microflora in obstetric patients with suppurative septic postpartum complications.Methods. A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology No. 2 of the Omsk State Medical University and the Department of Gynecology of the Omsk Regional Clinical Hospital. The study included 123 cesarean section patients treated from January 2013 to December 2022 who were divided into three groups: Group A — uncomplicated course of postpartum endometritis, n = 55; Group B — complicated forms of postpartum endometritis, n = 48: B1 — local complications (suture failure following cesarean section; parametritis) n = 29; B2 — pelvic peritonitis, n = 19; Group C — septic complications following critical obstetric conditions, n = 20. The pathogenic microflora of uterine and abdominal cavities was examined; the extent of contamination with a pathogen and sensitivity to antibacterial drugs were determined. The isolated microorganisms were identified using a MicroTax bacteriological analyzer (Austria), Vitek2 Compact (France) and routine methods; a disk diffusion method was employed to determine the sensitivity of microorganisms to antibacterial drugs. Calculations were performed using licensed Microsoft Office Excel 2013 and Statistica 10 programs (StatSoft Inc., USA). Nonparametric nominal data were compared using Pearson’s chi-squared test with p-value determination.Results. The pathogenic microflora was dominated by S. epidermidis, E. faecalis, E. coli, and E. faecium. In 2018–2022, a statistically significant decrease was observed in the isolation rate of S. epidermidis (p = 0.016), E. faecalis (p < 0.001), and E. faecium (p = 0.05). The highest resistance was exhibited by bacteria to the following antibiotics: S. epidermidis — cephalosporins (30.16%); E. faecalis — fluoroquinolones (33.33%); E. coli — cephalosporins (65.91%) and β-lactamase-resistant penicillins (40.91%); E. faecium — aminopenicillins (64.10%) and fluoroquinolones (50.0%); А. baumannii — fluoroquinolones, cephalosporins, carbapenems (100%), and aminoglycosides (84.2%). A contamination assessment revealed a high titer of isolated microorganisms in 60.53% of cases. We found a statistically significantly higher isolation rate of S. еpidermidis (p < 0.001), E. faecium (p = 0.01), and A. baumannii (p = 0.02) in the setting of pelvic peritonitis as compared to uncomplicated endometritis. In the case of suppurative septic complications due to critical obstetric conditions, the isolation rate was higher for S. еpidermidis (p <0.001), E. coli (p = 0.04), E. faecium (p = 0.005), A. baumannii (р<0.001), and K. рneumoniae (p = 0.04).Conclusion. The antibiotic resistance of pathogenic microorganisms calls for the development of new organ system support technologies and the use of methods capable of sorbing microorganisms and their toxins in the area of inflammation.
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