剖宫产产妇术后切口感染的病原学特点及影响因素分析

Etiology and risk factors of incision infection after cesarean section

目的探究剖宫产术后切口感染的病原学特点,分析其影响因素,为临床治疗和护理提供参考依据。方法选取2015年1月-2016年12月于医院行剖宫产术的产妇828例的临床资料,调查产妇术后切口感染情况,对切口部位的分泌物进行培养与鉴定,分析感染的病原菌分布并行药敏试验;收集产妇的年龄、血红蛋白、妊娠并发症、医源性操作情况、是否初产妇、手术时间等临床资料,采用单因素及多因素Logistic回归分析方法分析感染的影响因素。结果 828例剖宫产产妇术后有51例发生切口感染,感染发生率为6.16%;51例感染产妇共检出病原菌73株,其中革兰阴性菌41株占56.16%、革兰阳性菌29株占39.73%、其他3株占4.11%;主要革兰阴性菌对美罗培南及亚胺培南较为敏感,主要革兰阳性菌对莫西沙星及万古霉素较敏感;多因素Logistic回归分析结果显示,贫血、合并妊娠并发症、手术时间过长是术后切口感染的影响因素(P<0.05)。结论剖宫产术后感染的主要病原菌均对常规使用的抗菌药物有一定的耐药性,临床工作中要严格执行抗菌药物的使用规范,避免过多使用抗菌药物;剖宫产术后切口感染往往是多种因素共同作用,临床上应该针对这些高危因素采取综合性的护理措施,有创护理操作中注意无菌操作,积极预防切口感染的发生。

OBJECTIVE To investigate the etiology of incision infection after caesarean section and to analyze its risk factors,so as to provide references for clinical treatment and nursing.METHODS A total of 828 women who underwent caesarean section in the hospital from Jan.2015 to Dec.2016 were selected.Through the cultivation and identification of secretions in the incision area,the distribution of pathogenic diseases was analyzed and the drug susceptibility tests were carried out.The clinical data of the women were collected,including age,hemoglobin,pregnancy complications,iatrogenic operation,primipara,operation time,and the risk factors of infection were explored using univariate and multivariable logistic regression analysis.RESULTS Among 828 cases of women with caesarean section,there were 51 cases of incision infection,and the infection rate was 6.16%.A total of 73 strains of pathogenic bacteria were detected from 51 cases of infected women,including 41 cases of gram-negative bacteria,29 cases of gram-positive bacteria,and 3 strains of others,accounting for 56.16%,39.73%,and 4.11%,respectively.The main gram-negative bacteria were sensitive to meropenem and imipenem,and the main grampositive bacteria were sensitive to moxifloxacin and vancomycin.Multivariable logistic regression analysis showed that anemia,pregnancy complications,and long surgical time were independent risk factors for incision infection after cesarean section（P〈0.05）.CONCLUSION The main pathogens of infection after cesarean section have certain resistance to commonly used antibiotics,suggesting we should strictly enforce the use specification of antibiotics in clinical work,and avoid excessive use of antibiotics.Incision infection after cesarean section is often the combined action of various factors,so we should take comprehensive nursing measures according to these risk factors in clinic,and nursing operation especially should pay attention to aseptic operation,so as to actively prevent the happening of incision infection.