剖宫产产妇术后感染病原菌分布情况及CRP预测的最佳临界点

Distribution of Pathogens Causing Postoperative Infections in Women with Cesarean Section and Analysis of Optimal Cutoff Threshold of CRP for Prediction of Incision Infection

目的研究剖宫产产妇术后感染病原菌分布情况及C反应蛋白(CRP)预测的最佳临界点。方法选取我院2021年4月-2022年4月收治的965例剖宫产产妇作为研究对象,根据患者术后是否发生感染分为感染组(n=35)和对照组(n=930)。分析感染组产妇切口分泌物病原菌情况,对比两组患者产前、产后24h、产后48h、产后72h以及产后96h的CRP水平,分析不同时间点CRP水平对于产妇术后切口感染的预测价值。结果35例感染者总共分离出42例病原菌株,革兰阴性菌总共29株,占69%,主要为大肠埃希菌和阴道加德纳菌,分别占48.27%和31.03%;革兰阳性菌11株,占26.19,主要以溶血性链球菌和粪肠球菌为主,分别占63.63%和27.27%;真菌2株,占4.76%;阴性组产妇产后72h和产后96h的CRP水平显著低于产后24h(P<0.05);感染组产妇产后48h和产后72h的CRP水平显著高于产前和产后24h,产后96h显著低于产后48h和72h,差异具有统计学意义(P<0.05);感染组产妇产后48h、产后72h以及产后96h的CRP水平均显著高于对照组产妇(P<0.05);产后48h对于产妇术后感染的预测价值最高(P<0.05)。结论剖宫产产妇术后切口感染病原菌主要以革兰阴性菌为主,CRP预测的最佳时间为产后48h。

Objective To analyze the distribution of pathogens causing postoperative infections in women with cesarean section,and to study the optimal cutoff threshold of C-reactive protein(CRP)for prediction of infection.Methods A sample of 965 women underwent cesarean section in our hospital from April 2021 to April 2022 were enrolled,and classified into two groups according to the presence or absence of postoperative infection,infection group(n=35)and control group(n=930).The pathogen profile of incisional secretions was detected.CRP levels before,24h,48h,72h and 96h after delivery were compared,then the predictive value of CRP at different time points for maternal postoperative incision infection was evaluated.Results A total of 42 strains of pathogens were isolated from 35 infected cases,with 29 strains of Gram-negative bacteria(69%),mainly Escherichia coli and Gardnerella vaginalis,accounting for 48.27%and 31.03%respectively.There were 11 strains of Gram-positive bacteria,accounting for 26.19%,mainly Hemolytic streptococcus and Enterococcus faecalis,accounting for 63.63%and 27.27%respectively.There were 2 strains of fungi,accounting for 4.76%.CRP levels in control group at 72h and 96h after delivery were significantly lower than those at 24h after delivery(P<0.05).CRP levels in control group at 72h and 96h after delivery were significantly higher than those before,24h and 96h after delivery,with statistical difference(all P<0.05).CRP levels at 24h,72h and 96h after delivery were significantly elevated in infection group compared with contorl group at corresponding time points(all P<0.05).Among the values at different time points,CRP at 48h after delivery had the highest predictive value for postpartum infection(P<0.05).Conclusion Gram-negative bacteria are the main pathogens causing postpartum cesarean section infection,and CRP at 48h after delivery has high efficacy for prediction of incision infection.