阴道试产中转剖宫产术后医院感染及影响因素分析  

Influencing factors of incision infection after vaginal trial production transfer cesarean section

作　　者：吴思奇 孟玉翠[1] 侯梦茹 许艳蕾[1] 戎惠娟 WU Siqi;MENG Yucui;HOU Mengru;XU Yanlei;RONG Huijuan(Shijiazhuang Obstetrics and Gynecology Hospital,Shijiazhuang,Heibei 050017,China)

机构地区：[1]石家庄市妇产医院感控处,河北石家庄050017

出　　处：《医药前沿》2021年第27期1-4,共4页Journal of Frontiers of Medicine

基　　金：石家庄市科技局项目:手术部位感染相关危险因素及高危人群的模型识别方法的研究(195460155)。

摘　　要：目的:分析中转剖宫产手术医院感染的发生特点及危险因素,为降低医院感染提供科学依据。方法:选取2019年1月-12月行阴道试产中转剖宫产手术的产妇1233例,对产妇术后医院感染病原菌分布及其危险因素进行调查与分析。结果:1233例阴道试产中转剖宫产手术产妇中36例发生医院感染,感染率为2.92%。共检出34株病原菌,其中革兰阴性杆菌占52.94%,革兰阳性杆菌占38.24%,其他病菌感染占8.82%。大肠埃希菌对氨苄西林、复方磺胺耐药率较高,均>60%,对美罗培南及亚胺培南较为敏感;金黄色葡萄球菌对青霉素、克林霉素、克拉霉素、红霉素、阿奇霉素耐药率较高,均>70%,对莫西沙星、利奈唑胺、万古霉素、替考拉宁、利福平、呋喃妥因及阿米卡星较敏感。多因素Logistic回归分析结果显示,产前发热、术前使用抗菌药物、术中出血量≥400 mL、有妊娠合并症、胎膜早破等因素是阴道试产中转剖宫产术后医院感染的影响因素。结论:阴道试产中转剖宫产手术医院感染发生率较高,常见革兰阴性菌为大肠埃希菌,革兰阳性菌以金黄色葡萄球菌为主。应重点关注术前发热、术中出血量≥400 mL、有妊娠合并症、胎膜早破等重要危险因素,严格无菌操作、积极治疗相关基础疾病、控制术中出血量,术前预防性应用抗生素等,可以有效降低剖宫产术后医院感染的发生率。Objective To analyze the influencing factors,pathogenic microorganisms,and drug resistance of incision infection after vaginal trial production transfer cesarean section,providing scientific basis to reduce the infection of incision.Methods A total of 1233 women who underwent cesarean section after vaginal trial production from January 2019 to December 2019 were selected to investigate and analyze the pathogen distribution and risk factors for incision infection after obstetrics.Results 36 surgical incision infections happen in 1233 cases of cesarean section,with infection rate of 2.92%.34 strains of pathogenic bacteria were detected,with gram-negative bacilli(52.94%),gram-positive bacillus(38.24%),and other pathogens accounting for 8.82%.The resistance rate of the main gram-negative bacteria to ampicillin and cotrimosulfamide were higher than 60%,while sensitive to meropenem and imipenem.The resistance rate of the main gram-positive bacteria to penicillin,clindamycin,azithromycin were higher than 70%,while sensitive to moxifloxacin and linezolid.Multivariate Logistic regression analysis showed that incision infection was associated with prenatal fever,pregnancy complications,intraoperative blood loss≥400 mL and preoperative drug use.Conclusion The incidence of incision infection was higher in the transfer cesarean section.Escherichia coli and Staphylococci were the main intestinal bacteria.Attentions should be paid to risk factors such as preoperative fever,intraoperative blood loss≥400 mL,pregnancy complicated,and premature rupture of membranes.Preoperative prophylactic use of antibiotics should be combined with drug sensitivity test to avoid the occurrence of postoperative incision infection.The incidence of postoperative incision infection after cesarean section can effectively reduced by strictly abide by the aseptic operation,actively treat the related basic diseases,control the amount of intraoperative blood loss and preoperative prophylactic application of antibiotics.

关 键 词：剖宫产 手术部位感染 医院感染 病原微生物 危险因素 

分 类 号：R711.73[医药卫生—妇产科学]