剖宫产术后腹部切口感染的病原学特点及影响因素分析

Etiological characteristics and risk factors for poor incision healing of cesarean section

目的分析剖宫产术后腹部切口感染的病原学特点及影响因素。方法回顾性分析2017年1月至2018年1月南京医科大学附属苏州医院苏州市立医院剖宫产的6322例产妇临床资料,分析术后腹部切口感染病原菌分布及耐药性,探讨术后腹部切口感染的相关影响因素。结果 6322例产妇术后腹部切口感染67例,感染率1.06%,我院伤口感染标本共培养出91株病原菌,其中革兰阴性菌43株(47.25%)、革兰阳性菌45株(49.45%)、真菌3株(3.30%)。革兰阴性菌与革兰阳性菌主要菌种分别为大肠埃希菌和金黄色葡萄球菌,对多种抗生素具有耐药性。初产妇、既往剖宫产史、肥胖(BMI≥30)、紧急剖宫产、羊水污染(Ⅱ°及Ⅲ°)是发生剖宫产术后腹部伤口感染的影响因素(P<0.05),而年龄、胎膜破裂、贫血、糖尿病、妊娠期高血压疾病与伤口感染无明显相关性。结论积极筛查感染影响因素,辨别高危人群,并针对伤口感染病原菌选取有效抗菌药物,有利于降低剖宫产腹部伤口感染率。

Objective To investigate etiological characteristics and risk factors for poor incision healing of cesarean section.Methods A total of 6322 pregnant women who underwent cesarean section in the hospital from Jan.2017 to Jan.2018 were enrolled in the study.The clinical data of all patients were collected to explore the etiological characteristics and relevant factors.Results Totally 67(1.06%)cases had poor incision healing.A total of 91 strains were co-cultured in 67 patients,including 43 of gram-negative bacteria,accouting for 47.25%,45 strains of gram-positive bacteria,accounting for 49.45%,and 3 strains of fungi,accounting for 3.30%.The main strains of gram-negative bacteria and gram-positive bacteria were Escherichia coli and Staphylococcus aureus,which were resistant to various antibiotics.The primipara,history of cesarean section,obesty(BMI≥30),emergency cesarean section,and amniotic fluid contamination(Ⅱ°and Ⅲ°)were the risk factors of abdominal wound infection(P<0.05).There was no significant correlation between age,membrane rupture,anemia,diabetes,hypertensive disorders complicating pregnancy and wound infection.Conclusion We should timely pay attention to the risk factors of pregnant women and select effective antibacterial drugs for wound infection pathogens,which is conductive to reducing the abdominal wound infection rate of cesarean section.