疤痕子宫患者再次剖宫产术后产褥感染的危险因素与病原学和耐药性分析

Risk factors,etiology and drug resistance of puerperal infections in patients with uterine scar after second cesarean section

目的探讨疤痕子宫患者再次剖宫产术后产褥感染的危险因素、病原学和耐药性,为临床治疗提供参考依据。方法自2015年1月-2016年6月前瞻性收集医院收治的疤痕子宫再次行剖宫产术的孕产妇382例,分析疤痕子宫患者再次剖宫产术后产褥感染的发生率、危险因素、病原学和耐药性。结果 382例孕产妇,共31例发生产褥感染,感染率为8.12%;多因素回归分析显示,凶险型前置胎盘、凶险型前置胎盘合并胎盘植入、产后出血和孕产妇阴道炎是疤痕子宫患者再次剖宫产术后产褥感染的独立危险因素(P<0.05);共培养出26株病原菌,以革兰阴性菌为主,占65.38%,革兰阴性菌耐药率最高的是头孢他啶,为41.18%。结论疤痕子宫患者再次剖宫产术后产褥感染率较高,凶险型前置胎盘、凶险型前置胎盘合并胎盘植入、产后出血和孕产妇阴道炎是高危因素,革兰阴性菌较为常见,对青霉素和头孢他啶耐药率较高。

OBJECTIVE To explore the risk factors, etiology and drug resistance of puerperal infection in patients with uterine scar after second cesarean sections, so as to provide references for clinical treatment. METHODS From Jan. 2015 to Jun. 2016, 382 cases of maternal with uterine scar after second cesarean section admitted to our hospital were prospectively collected in the study. The incidence, risk factors, pathogens and drug resistance of puerperal infection in patients with uterine scar after second cesarean section were analyzed. RESULTS Of the 382 cases of pregnant women, 31 cases （8. 12%） developed puerperal infection, with the infection rate of 8. 12%. Multivariate regression analyzis showed that placenta previa, placenta previa complicated with placenta accreta, postpartum hemorrhage and maternal vaginitis were independent risk factors of puerperal infection in patients with uterine scar after second cesarean section again （P〈0.05）. Totally 26 strains of pathogenic bacteria were cul- tured. Gram-negative bacteria were common in puerperal infection, accounting for 65.38%. The highest resistant rate of gram-negative bacteria was ceftazidime, which was 41.18%. CONCLUSION The patients with uterine scar after second cesarean section get a high puerperal infection rate. Placenta previa, placenta previa complicated with placenta accreta, postpartum hemorrhage and maternal vaginitis are risk factors. Gram-negative bacteria are common, and the resistant rates of penicillin and cephalosporin ceftazidime are higher.