高龄产妇术后感染病原菌分布与影响因素分析

An Analysis of Pathogenic Bacteria Distribution and Influencing Factors of Postoperative Infection in Elderly Maternal

目的研究高龄产妇术后感染病原菌分布及耐药性,并探讨感染发生的危险因素。方法选取首都医科大学附属北京朝阳医院西院和北京大学首钢医院2010年至2019年接收的1136例高龄产妇的临床资料,收集产妇一般资料及术后相关情况,对术后临床送检样本进行细菌鉴定和药敏试验,并对可能导致术后感染发生的影响因素进行采用Logistic回归分析。结果高龄产妇术后发生感染112例,感染率为13.82%,感染患者送检标本分离病原菌132株病原菌,其中革兰阴性菌68株(占51.52%),主要为大肠埃希菌(48株,占36.36%),58例为革兰阳性菌株(占43.94%),以金黄色葡萄球菌(39株,占29.55%)为主;真菌6株(占4.55%)。进一步通过多因素回归分析结果显示,产妇的体质指数、术中出血量、胎膜早破、手术进行时间、侵入性操作、患有妊娠糖尿病以及手术季节均是构成高龄产妇术后感染发生的独立危险因素(均P<0.05)。结论高龄产妇术后感染的危险因素较多,医护人员应参考病原菌分布及耐药性特点以及造成感染的危险因素,制定针对性的护理干预对策进行预防措施。

Objective To study the distribution of pathogenic bacteria and drug resistance of postoperative infection in elderly patients,and to explore the risk factors of infections.Methods The clinical data of 1136 elderly parturients in Beijing Chaoyang Hospital Affiliated to Capital Medical University and Shougang Hospital of Peking University from 2010 to 2019 were collected for the study.The general information of the parturients and postoperative related information were collected,and the postoperative clinical examination samples were tested for bacteria Identification and drug susceptibility.A logistic regression analysis of the factors that could lead to postoperative infection was conducted.Results 112 cases of senile parturients had postoperative infections,with the infection rate 13.82%.The infected patients submitted specimens and we isolated 132 pathogens,of which 68 were Gram-negative bacteria(51.52%),mainly Escherichia coli 48 strains,(36.36%),while 58 cases were Gram-positive strains(43.94%),mainly Staphylococcus aureus(39 strains,29.55%),and 6 cases were fungi(4.55%).The results of multivariate regression analysis showed that maternal body mass index,intraoperative blood loss,premature rupture of membranes,operation time,invasive procedures,gestational diabetes,and operation season were all associated with the occurrence of postoperative infections in elderly women as independent risk factors(all P<0.05).Conclusion There are multiple risk factors identified for postoperative infection in elderly parturients.Medical staff should refer to the distribution of pathogenic bacteria and the characteristics of drug resistance and the risk factors that could cause infections to develop targeted nursing interventions for preventive measures.