初产妇经阴道分娩会阴侧切切口感染的病原菌分布及影响因素分析

Distribution and influencing factors of pathogens in vaginal delivery of perineal side incision infection and nursing preventive measures

目的研究经阴道分娩的初产妇会阴侧切术后切口感染的病原菌特点及耐药,分析影响因素。方法收集2014年1月-2019年5月在本院产科行会阴侧切术的2186例初产妇临床资料,采集切口脓性分泌物送细菌室进行细菌鉴定和药敏试验,统计学分析确定切口感染的影响因素。结果2186例会阴侧切的初产妇有28例发生切口感染,发生率为1.28%,检出32株病原菌,其中革兰阴性菌22株,占68.75%,革兰阳性菌9株,占28.13%,真菌感染1例,占3.13%。检出的革兰阴性菌对亚胺培南和美罗培南敏感,对氯霉素耐药率最高。革兰阳性菌对庆大霉素耐药率最高,而对万古霉素敏感。多因素Logistic回归分析显示,产道裂伤、妊娠糖尿病、胎膜早破、生殖道感染和产程时间≥16 h是初产妇会阴侧切切口感染的独立的危险因素(P<0.05)。结论初产妇会阴侧切切口感染的病原菌以革兰阴性菌为主,对亚胺培南和美罗培南敏感,针对感染的影响因素采取针对性护理措施,可以降低感染的发生率。

Objective To study the characteristics and drug resistance of pathogenic bacteria in vaginal infection after vaginal delivery,and analyze the influencing factors.Methods The clinical data of2186 primiparas from the Department of Obstetrics.and Gynecology in our hospital from January to May 2019 were collected.The incision purulent secretions were collected and sent to the bacteria room for bacterial identification and drug susceptibility test.Statistical analysis was performed to determine the influencing factors of incision infection.Results There were 28 cases of incision infection in 2186 cases of primiparas with perineal side-cutting,and the incidence rate was 1.28%;32 pathogens were detected,of which 22 were Gram-negative bac-teria,accounting for 68.75%,and 9 were Gram-positive bacteria,accounting for 28.13%.1 case of fungal infection accoun-ted for 3.13%.The detected Gram-negative bacteria were sensitive to imipenem and meropenem,and had the highest resist-ance to chloramphenicol.Gram-positive bacteria have the highest resistance to gentamicin and are sensitive to vancomycin.,Univariate and multivariate Logic regression analysis showed that birth canal laceration,gestational diabetes,premature rupture of membranes,genital tract infection,and labor time≥16 h were independent risk factors for puberty perineal lateral incision infection.Conclusion The pathogens of primiparaic perineal incision infection are mainly Gram-negative bacteria,and sensi-tive to imipenem and meropenem.Targeted nursing measures for the influencing factors of infection can reduce the incidence of infection.