剖宫产术后感染病原菌与抗菌药物预防使用时机分析

Analysis of pathogens causing postoperative infection in puerperant women after caesarean section and the time for preventive use of antibiotics

目的探讨剖宫产妇术后感染病原菌与抗菌药物预防使用时机。方法选择医院2014年12月-2017年12月行剖宫产分娩的产妇3 000例为研究对象,随机分为A、B、C组,各1 000例。A组产妇术前30min静滴头孢呋辛,B组于产妇术后30min与术后3d分别静滴头孢呋辛,C组于产妇术后至病房静滴头孢呋辛;采集产妇剖宫产术后感染患者血液、体液和分泌物标本,分离鉴定病原菌,并分析抗菌药物使用时机。结果行剖宫产分娩的产妇术后感染率为3.17%(95/3 000);其中尿路感染35例,切口感染27例,产褥感染18例,宫腔感染15例;B组术后感染率为1.00%(10/1000)低于A组2.70%(27/1000)和C组5.80%(58/1000)(P<0.05),且A组低于C组(P<0.001)。共培养分离病原菌117株,其中革兰阴性菌69株占58.97%,以大肠埃希菌和铜绿假单胞菌为主;革兰阳性菌48株占41.03%,以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主。三组术中出血量和手术时间差异无统计学意义;C组住院时间为(6.52±1.10)d长于A组(4.45±1.21)d、B组(4.51±1.38)d(P<0.001);而A、B组住院时间差异无统计学意义(P=0.151)。结论剖宫产妇术后感染中,革兰阴性菌为其主要致病菌,于产妇术后30min与术后3d静滴头孢呋辛效果较好,可降低产妇术后感染率。

OBJECTIVE To explore the pathogens causing postoperative infection in puerperant women after caesarean section and the time to for preventive prevent the use of antibiotics.METHODS A total of 3000 cases of puerperant women with cesarean delivery from Dec.2014 to Dec.2017 in our hospital were randomly divided into groups A,B,C,with 1000 cases in each group.The puerperant women in group A received intravenous injection with cefuroxime 30 min before the operation,group B received intravenous injection with cefuroxime 30 min and 3 dafter the operation,group C received intravenous injection with cefuroxime after the puerperant women were moved to ward.The samples of blood,body fluid and secretions of the infected patients after cesarean section were collected,the pathogens were isolated and identified,and the time to use antibiotics was analyzeds.RESULTS In the3000 cases of parturient women with cesarean delivery,95 cases were infected after operation,and the infection rate was 3.17%.Among the 95 cases of postoperative infection,35 cases were urinary tract infection,27 cases were incision infection,18 cases were puerperium infection and 15 cases were uterine cavity infection.The infection rate of group B was 1.00%(10/1000),significantly lower than that of group A and group C,which were2.70%(27/1000)and 5.80%(58/1000),respectively and the infection rate of group A was significantly lower than that of group C(P<0.05).117 strains of pathogenic bacteria were isolated from 95 cases of postoperative infection,including 69 strains of gram-negative bacteria(58.97%)and 48 strains of gram-positive bacteria(41.03%).Gram-negative bacteria were mainly Escherichia coli and Pseudomonas aeruginosa,whereas Staphylococcus aureus and coagulase-negative Staphylococcus were the most common gram-positive bacteria.There was no significant difference in bleeding volume and operative time among the three groups.The hospitalization time in group C(6.52±1.10)d was significantly longer than that in group A(4.45±1.21)d and group B(4.51±1.38)d(P<0.05),but there was no significant difference in hospitalization time between group A and group B(P=0.151).CONCLUSION Gram-negative bacteria are the main pathogens causing infection after cesarean section.Intravenous drip of cefuroxime 30 minutes and 3 days after cesarean section is effective and can reduce the infection rate of postpartum women.