剖宫产产妇术后切口感染的病原菌特点及危险因素分析

Pathogen characteristics and risk factors of incision infection after cesarean delivery

目的研究剖宫产产妇切口术后发生感染的病原菌特点及危险因素分析。方法选取2015年1月-2018年6月在本院行剖宫产的产妇1468例,收集术后感染切口分泌物进行细菌培养并鉴定病原菌种,对产妇的临床资料采用单因素和多因素Logistic回归分析其感染的危险因素。结果1486例剖宫产产妇切口术后确诊64例发生感染,发生率为4.31%,共培养出68株病原菌,其中革兰阴性菌48株,占70.59%,革兰阳性菌14株,占20.59%,真菌6株,占8.82%。单因素和进一步Logistic回归分析显示,手术时间≥1h、阴道指检次数≥3次、无预防使用抗生素、术中出血量≥400ml和试产时间≥8h是剖宫产产妇切口术后发生感染的独立危险因素(P<0.05)。结论剖宫产产妇切口术后发生感染的病原菌以革兰阴性菌为主,针对危险因素采取预防措施,可以预防感染发生,降低术后感染的发生率。

Objective To study the characteristics and risk factors of pathogenic bacteria after infection in cesarean section. Methods A total of 1 468 cases of cesarean section in our hospital from January 2015 to June 2018 were collected. The incision secretions were collected for bacterial culture and pathogens. Univariate and multivariate Logistic regression analysis of maternal clinical data was used to analyze the risk factors for infection. Results A total of 64 cases of infection were diagnosed in 1 486 cases of cesarean section. The incidence rate was 4. 31%. A total of 68 pathogens were cultured,including 48 cases of Gram-negative bacteria,accounting for 70. 59%,and 14 strains of Gram-positive bacteria,accounting for 20. 59%,fungal infection in 6 cases,accounting for 8. 82%,single factor and further Logistic regression analysis showed that surgical time ≥1 h, vaginal fingertips ≥3 times,no preventive use of antibiotics,intraoperative blood loss ≥400 ml and trial production time ≥8 h were independent risk factors for infection after cesarean section ( P < 0. 05). Conclusion Gram-negative bacteria are the main pathogens for infection after cesarean section. The prevention measures for risk factors can prevent infection and reduce the incidence of postoperative infection.