剖宫产术后产妇医院感染危险因素分析及病原菌分布、药敏耐药性

Analysis of the risk factors of nosocomial infection of puerpera after cesarean section and the distribution and the drug resistance of the pathogenic bacteria in susceptility testing

目的:调查本院剖宫产产妇术后医院感染情况及危险因素并提出预防措施。方法:回顾性收集2018年6月-2022年6月在本院产科经剖宫产分娩的3538例产妇临床资料,根据术后是否发生医院感染分为感染组和对照组,统计感染组感染部位并对病原菌进行培养分析和药敏实验,比较两组产妇临床资料差异并分析产妇术后发生医院感染的影响因素。结果:剖宫产产妇术后发生医院感染274例(7.7%),感染部位以手术切口(31.8%)、泌尿生殖系统(29.6%)及上呼吸道(21.2%)为主,感染病原菌以大肠埃希菌(29.5%)、铜绿假单胞菌(23.4%)、肺炎克雷伯菌(22.6%)等革兰阴性菌为主,对喹诺酮类抗生素敏感;多因素logistic回归分析显示,阴道检查≥3次、住院时间≥7d、妊娠并发症、贫血、妊娠期糖尿病、导尿管拔管时间≥24h均为剖宫产产妇术后发生医院感染的独立危险因素(P<0.05),而高文化程度则是剖宫产产妇术后发生医院感染的独立保护因素(P<0.05)。结论:本次调查的剖宫产产妇术后医院感染发生率7.7%,感染部位主要分布于手术切口、泌尿生殖系统及上呼吸道,以革兰阴性菌感染为主,对喹诺酮类药物敏感,阴道检查次数、住院时间、妊娠并发症、贫血、妊娠合并糖尿病、导尿管拔管时间、文化程度均为剖宫产产妇术后发生医院感染的影响因素。

Objective:To investigate the status and the risk factors of nosocomial infection of puerpera after cesarean section,and to provide the preventive measures for nosocomial infection.Methods:The clinical data of 3538 puerpera delivered by cesarean section from June 2018 to June 2022 were collected retrospectively.The puerpera were divided into group A(parturients with nosocomial infection)and group B(parturients without nosocomial infection)according to the situation of the nosocomial infection.The infection sites of the parturients were counted.And the pathogenic bacteria of the infection of the puerpera were cultured and analyzed,and the susceptibility testing of the pathogenic bacteria was conducted.The differences of the clinical data of the puerpera were compared between the two groups.And the influencing factors of the nosocomial infection of the puerpera after cesarean section were analyzed.Results:There were 274(7.7%)puerpera with nosocomial infection after cesarean section.The main infection sites of the puerpera were surgical incision(31.8%),genitourinary system(29.6%),and upper respiratory tract(21.2%).The pathogenic bacteria of the infection of the puerpera were mainly gram negative bacteria,such as Escherichia coli(29.5%),pseudo-monas aeruginosa(23.4%),and Klebsiella pneumoniae(22.6%),and which all were sensitive to quinolones antibiotics.Multiple logistic regression analysis showed that the vaginal examination during labor≥3 times,the hospital stay≥7d,the pregnancy complications,the anemia,the gestational diabetes mellitus,the catheter used time≥24h of the puerpera were all the independent risk factors of their nosocomial infection after cesarean section(P<0.05).The high education level of the puerpera was an independent protective factor of their nosocomial infection after cesarean section(P<0.05).Conclusion:The incidence of nosocomial infection of the puerpera after cesarean section is 7.74%in this investigation.The infection sites are mainly located in the surgical incision,urogenital system,and upper respiratory tract.The pathogenic bacteria of the nosocomial infection are mainly caused by gramnegative bacteria,and which are sensitive to quinolones.The frequency of vaginal examination during labor,the duration of hospitalization,the preg-nancy complications,the anemia,and the gestational diabetes mellitus,the time of catheter used,and the educational level of the puerpera are all the factors influencing their nosocomial infection after cesarean section.