剖宫产术后感染影响因素及病原学特征分析

doi:10.12183/j.scjpm.2022.0665

摘要/Abstract

摘要： 目的探讨剖宫产术后并发感染的影响因素,并分析剖宫产术后发生感染的病原学特征以及相关耐药性。方法以海口市某医院2018年1月1日至2021年12月31日进行剖宫产的产妇为研究对象,对研究期间所有剖宫产产妇进行回顾性资料收集及产后监测至出院,监测内容为是否发生术后并发症。采用描述流行病学分析方法对术后感染、致病菌及其耐药情况展开分析,采用多因素Logistic回归分析方法对剖宫产术后并发感染影响因素进行分析。结果共有3 012例剖宫产产妇纳入研究,其中年龄≤35岁2 015例,占66.90%;有剖宫产史者占16.70%。术后并发感染146例,发生率为4.85%。分离培养出致病菌178株,以大肠埃希菌（52株,29.21%）、肺炎克雷伯菌（24株,13.48%）、金黄色葡萄球菌（39株,21.91%）为主,均对左氧氟沙星、阿米卡星及亚胺培南的耐药性较低。多因素Logistic回归分析结果显示,年龄≥35岁（OR=1.871）、妊娠期糖尿病（OR=2.532）、营养不良（OR=4.952）、手术指征项数>2项（OR=2.305）、留置导尿管时间>24 h（OR=2.161）、未应用抗菌药物（OR=1.767）是剖宫产产妇术后并发感染的危险因素。结论剖宫产术后感染的危险因素众多,致病菌以革兰阴性菌为主。可结合医院致病菌及耐药情况,合理给予预防用药,有效控制术后感染发生率。

关键词: 剖宫产, 术后感染, 病原菌, 影响因素

Abstract: Objective To explore the influencing factors of infection after cesarean section, and analyze the pathogenic characteristics and drug resistance of infection after cesarean section. Methods Taking parturients who underwent cesarean section from January 1, 2018, to December 31, 2021, in a hospital in Haikou as the research object, retrospective data collection and postpartum monitoring to discharge were conducted for all cesarean section parturients during the study period. The monitoring content was whether there were postoperative complications. The descriptive epidemiological analysis method was used to analyze postoperative infection and pathogenic bacteria and their drug resistance, and the multivariate Logistic regression analysis method was used to analyze the influencing factors of infection after cesarean section. Results A total of 3 012 cesarean section parturients were included in the study, of which 2 015 cases were ≤35 years old, accounting for 66.90%; 16.70% had a history of cesarean section. Postoperative infection occurred in 146 cases, with an incidence rate of 4.85%. A total of 178 strains of pathogenic bacteria were isolated and cultured, mainly Escherichia coli （52 strains, 29.21%）, Klebsiella pneumoniae （24 strains, 13.48%）, and Staphylococcus aureus （39 strains, 21.91%）, and all of them had low resistance to levofloxacin, amikacin, and imipenem. Multivariate Logistic regression analysis showed that age ≥35 years old （OR=1.871）, gestational diabetes mellitus （OR=2.532）, malnutrition （OR=4.952）, more than 2 surgical indications （OR=2.305）, indwelling catheter time>24 h （OR=2.161）, and no antibiotics （OR=1.767） were risk factors for postoperative infection in cesarean section parturient. Conclusion There are many risk factors for infection after cesarean section, and the pathogenic bacteria are mainly Gram-negative bacteria. In case of abnormal conditions, clinical prophylactic drugs can be given reasonably according to the pathogenic bacteria and drug resistance in the hospital, effectively controlling the incidence of postoperative infection.

Key words: Cesarean section, Postoperative infection, Pathogenic bacteria, Influencing factor

中图分类号:

R719.8

王央玲, 黄海桃, 李娇珍, 罗阳珍, 吴小妹, 云笑. 剖宫产术后感染影响因素及病原学特征分析[J]. 华南预防医学, 2022, 48(6): 665-668.

WANG Yang-ling, HUANG Hai-tao, LI Jiao-zhen, LUO Yang-zhen, WU Xiao-mei, YUN Xiao. Influencing factors and pathogenic characteristics of infection after cesarean section[J]. South China Journal of Preventive Medicine, 2022, 48(6): 665-668.

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