剖宫产术后感染危险因素及病原菌分布分析

Risk factors and pathogenic bacteria distribution of cesarean section infection

目的:探讨剖宫产术后切口感染的危险因素及病原菌分布情况,为临床治疗提供依据。方法:选取2014年3月-2017年3月在河南省郑州人民医院行剖宫产术且术后发生切口感染的140例产妇的病例资料进行回顾性分析。统计产妇的产程、手术时间、胎膜早破情况、失血量、是否伴感染相关性基础疾病、预防性抗菌药物应用情况、入侵性检查次数、住院时间等,并进行单因素、多因素分析;采集切口处的分泌物做细菌培养,对主要病原菌的分布情况进行分析。结果:有生殖道感染、术前未用抗菌药物、阴道检查次数≥3次、手术时间≥1 h、失血量≥400 ml及有基础疾病为剖宫产术后感染的独立危险因素;其感染的病原菌以大肠埃希菌为主(81株,占46.29%),其次为铜绿假单胞菌(28株,占16.00%)和肠球菌属(25株,占14.29%)。结论:剖宫产术后切口感染与有生殖道感染、术前未用抗菌药物、阴道检查次数≥3次、手术时间≥1 h、失血量≥400 ml及有基础疾病相关;其感染病原菌主要为革兰阴性菌。

Objective： To investigate the risk factors of incision infection after cesarean section and the pathogenic bacteria distribution for providing a basis for clinical treatment. Methods： The clinical data were retrospectively analyzed of 140 puerperants with cesarean section infection who admitted from Mar. 2014 to Mar. 2017 in the Zhengzhou People＇s Hospital of Henan Province. The risk factors such as birth process, operation time, premature rupture of fetal membranes, blood loss, infection-associated underlying diseases, prophylactic antibiotics use, times of invasive examination and hospital stay etc. were assessed by univariate and multivariate analysis. The secretions from the incision were sampled for bacterial culture, and the distribution of the main pathogenic bacteria was analyzed. Results： The reproductive tract infection, no using of antibiotics pre-operation, vaginal examination undergone $ 3 times, operation time more than 1 hour, the blood loss $ 400 ml and exist of underlying disease were the independent risk factors for cesarean section infection. The main pathogenic bacteria were Escherichia coli （81 strains, 46.29%）, followed by Pseudomonas aeruginosa（28 strains, 16.00%） and Enterococcus（25 strains, 14.29%）. Conclusions：Incision infection after cesarean section is correlated with the reproductive tract infection, not use of antibiotics pre-operation, more than 3 times of vaginal examination, operation time more than 1 hour, the blood loss $ 400 ml and the underlying disease. The main pathogenic bacteria are gram-negative bacteria.