정상출산부 오로의 임상세균학적 관찰 = Clinico-Bacteriological Observation on Normal Postpartum Lochia

국문 초록 (Abstract)

본원 산부인과에서 1969년 1월 초부터 동연 3월말 사이 만 3개월간 질식 분만후 12-72시간(평균 39시간)내에 무균조작으로 자궁경관 및 후질궁융뷰에서 채취한 오로를 호기성과 혐기성 조건하에서 혈액한천배지 및 Thioglycollate배지에서 배양한 후 균의 분포를 분석 관찰하였으며 몇가지 항생제에 대한 감수성검사를 Disk방법으로 일부 균주에 대하여 시행하여 다음과 같은 결과를 얻었다. 1) 총 107례 중에서 균이 배양된 례는 101례로 94.3%이었고 배양되지 않았던 례는 6례로 5.7% 이었다. 균이 배양된 경우 2종의 균이 동시에 배양된 예가 제일 많아 36례이었고 단일균이 28례, 3종의 균이 18례, 4종의 균이 16례, 5종의 균이 3례로 각각 동시 배양되었다. 단 1균종이 배양된 28례 중에서는 E.coli가 7례로 가장 많았다. 유산균의 순수 배양례는 1례도 없었다. 2) 배양균들을 그 빈도순위로 보면 Unidentified Gram negative bacilli가 40.2%, Streptococci( -hemolytic, Viridans 포함)가 33.7%, Staphylococci(S. aureus, S. epidermis)와 Lactobacillus species가 각각 19.6%, E.coli가 18.7%, Micrococcus와 Corynebacterium species (Diphtheroids 포 함)이 각각 14.0%, Enterococcus가 10.1%, Coliform bacilli와 Hemophilus species가 각각 6.5%, Yeast like cells 가 4.7%, Unidentified Gram positive bacilli와 Clostridium species 가 각각 3.7%, Neisseria species가 1.9%, Bacterium anitratum, Proteus mirabilis, Klebsiella aerogenes와 Providence group이 각각 0.9%이었다. 3) 배양균의 분포와 제요인 즉 산모의 연령, 분만횟수, 분만방법, 회음절개 및 경관 열창등의 요 인들과의 상호관계를 살펴본 결과 배양균 분포와 밀접한 관계는 찾아 볼 수 없었다. 4) 항생제에 대한 감수성검사에서 각 균주에 대하여 감수성이 있는 항생제는 다음과 같은 것들 이었다. a) E.coli는 전례에서 Neomycin, Ampicillin과 Colistin에 Sensitive하였고 대부분의 경우에 Chloramphenicol과 Streptomycin에 Sensitive하였지만 일반적으로 Kanamycin에는 Moderately sensitive하였다. b) Staphylococcus는 전례에서 Methicillin과 Cloxacillin에 Sensitive하였고 대부분은 Leucomycin 과 Erythromycin에 Sensitive하였지만 일부는 Resistant하였다. c) Enterococci는 대부분 Ampicillin과 Erythromycin에 Sensitive하였고 일부는 Chloramphenicol 과 Neomycin에 Sensitive하고 일부는 Resistant하였다. d) Coliform bacilli는 전례가 Neomycin에 Sensitive하였고 대부분은 Chloramphenicol, Streptomycin, Colistin과 Ampicillin에 Sensitive 하였지만 Kanamycin에는 Moderately sensitive 하였다. e) Clostridium species는 Tetracycline과 Erythromycin에 Sensitive하였다.

다국어 초록 (Multilingual Abstract)

During the period from January 1 to March 31, 1969, lochia was taken for the bacteriological culture and sensitivity test from 107 patient of normal afebrile postpartum women, aged 20 to 40, who had given birth vaginally at the Dept. of Obstetrics and Gynecology, Naotional Medical Center, Seoul. The specimens were taken aseptically from cervical canal or posterior vaginal fornix within postpartum 12 to 72 hours (Av. 39 hrs.) and then cultured on blood agar or thioglycollate media under aerobic and anaerobic conditions. With cultured several organisms, sensitivity test was done by Disk method to some current antibiotics. The results were obtained as follows: 1. Among 107 cases, culture was positive in 101 cases (94.3%) and sterile cultrue(negative cultrue) was in 6 cases (5.7%). Among the above 101 cases of positive culture, mixed culture of two different bacteria were found the most commonly at the same time in 36 cases, pure culture in 28 cases, mixed culture of three bacteria in 18 cased, four bacteria in 16 cases and five bacteria in three cases. Among the above 28 cases of pure culture of Lactobacillus was sepcies found. 2. the cultured organisms and its incidence in order were as follows; Unidentified anaerobic gram negative bacilli in 40.2%, Streptococci (anaerobic, beta hemolytic and viridans) in 33.7%, Staphylococci (aureus and edpidermis) and Lactobacillus species in 19.6%, respectively, E. coli in 18.7%, Bacteroides in 15.9%, Micrococcus species and Corynebacterium species including Diphtheroids in 14.0%, respectively, Enterococcus in 10.1%, Coliform bacilli and Hemophilus species in 6.5%, respectively, Yeast like cells in 4.7%, Unidentified gram positive bacilli and Clostridium species in 3.7%, respectively, Neisseria species in 1.9%, Bacterium anitratum, Proteus miarbilis, Klebsilia aerogenes and Providence group in 0.9%, respectively. 3. Relationships between the distribution of cultured organisms and several factors such as age, parity, mode of delivery and presence or absence of episiotomy or cervical repair, were analysed. However no remarkable difference in distribution of cultured organisms could be found. 4. The results of sensitivity test (as to the sensitive antibiotics) were as follows; a) E. coli was sensitive to Neomycin, Ampicillin and Colistin in all cases. Most of them were sensitive to Chloramphenicol and Streptomycin. Generally, it was moderately sensitive to Kanamycin. b) Staphylococcus aureus was sensitive to Methicillin and Cloxacillin in all cases. Most of them were sensitive but part of them were resistnat to Leucomycin and Erythromycin. c) Most of Enterococci were snesitive to Ampicillin and Erythromycin but part of them were sensitive or resistant to Chloramphenicol and Neomycin. d) Coliform bacilli were sensitive to Neomycin in all cases and most of them were sensitive to Chloramphenicol, Streptomycin, Colistin and Ampicillin. They were moderately sensitive to Kanamycin. e) Clostridium species were sensitive to Tetracycline and Erythromycin in all cases.