剖宫产术后产褥感染影响因素及其预测模型构建

Influencing factors for postoperative puerperal infection in cesarean section patients and establishment of prediction model

目的探讨剖宫产术后产褥感染的病原菌分布特点及影响因素。方法选取658例2022年1月-2022年12月眉山市人民医院收治的剖宫产患者为研究对象,根据剖宫产术后产褥感染情况分为感染组33例和非感染组625例,统计剖宫产患者术后产褥感染的病原菌分布特点;比较两组临床资料,采用Logistic分析法分析剖宫产患者术后产褥感染的影响因素,并构建感染预测模型,分析其预测效能。结果剖宫产患者术后产褥感染发生率为5.02%,感染病原菌以革兰阴性菌占比较高;Logistic回归分析结果显示,有产后出血、有产前生殖道感染、有胎膜早破均是剖宫产患者术后产褥感染的影响因素(OR=7.078、8.071、8.338,P<0.05),构建的剖宫产患者术后产褥感染风险模型:Logit(P)=-4.068+产后出血×1.957+产前生殖道感染×2.088+胎膜早破×2.121,按照诊断概率Logit(P)绘制剖宫产患者术后产褥感染的受试者工作特征(ROC)曲线,当Logit(P)>0.1时,曲线下面积(AUC)值为0.794,95%CI为0.709~0.878。模型诊断敏感度为81.80%,特异度为72.40%。结论剖宫产患者术后产褥感染发生率较高,革兰阴性菌感染占比较高;产后出血、产前生殖道感染和胎膜早破均是剖宫产患者术后产褥感染的影响因素。

OBJECTIVE To explore the distribution of pathogens isolated from the cesarean section patients with postoperative puerperal infection and analyze the influencing factors.METHODS A total of 658 patients who underwent cesarean section in Meishan People′s Hospital from Jan 2022 to Dec 2022 were recruited as the research subjects and were divided into the infection group with 33 cases and the non-infection group with 625 cases according to the status of postoperative puerperal infection.The clinical data were compered between the two groups,logistic analysis was performed for the influencing factors for the postoperative puerperal infection in the cesarean section patients,the prediction model for infection was established,and the predictive efficiency of the model was analyzed.RESULTS The incidence of postoperative puerperal infection was 5.02%among the cesarean section patients.Gram-negative bacteria were dominant among the pathogens isolated from the patients with infection.The result of logistic regression analysis showed that postpartum hemorrhage,prenatal genital tract infection and premature rupture of membrane were the influencing factors for the postoperative puerperal infection in the cesarean section patients(OR=7.078,8.071,8.338,P<0.05).The established risk model for postoperative puerperal infection was as follows:Logit(P)=-4.068+postpartum hemorrhage×1.957+prenatal genital tract infection×2.088+premature rupture of membrane×2.121.Receiver operating characteristic(ROC)curves for the postoperative puerperal infection were drawn based on diagnostic probability Logit(P),when Logit(P)was more than 0.1,the area under curve(AUC)was 0.794,and 95%CI was 0.709-0.878.The sensitivity of the model was 81.80%for diagnosis,with the specificity 72.40%.CONCLUSION The incidence of postoperative puerperal infection is high among the cesarean section patients.The patients with gram-negative bacteria infection are dominant.Postpartum hemorrhage,prenatal genital tract infection and premature rupture of membrane are the influencing factors for the postoperative puerperal infection in the cesarean section patients.