产妇会阴侧切术后切口感染病原菌分布及相关因素

目的探讨产妇会阴侧切术后切口感染病原菌的分布特征，分析影响产妇会阴侧切切口感染的危险因素，为会阴侧切切口感染的防治提供依据。 方法选择2014年3月至2018年10月重庆市开州区人民医院产科收治的461例会阴侧切产妇为研究对象进行回顾性分析，依据细菌培养结果分为感染组（46例）和未感染组（415例）。统计会阴侧切后切口感染病原菌种类和构成比，采用Logistic非条件回归分析产妇会阴侧切切口感染的危险因素。 结果入组产妇会阴侧切切口感染率为9.98%（46/461）；共检出菌株43株，其中革兰阴性菌占53.49%（23/43），革兰阳性菌占39.53%（17/43）。大肠埃希菌和表皮葡萄球菌为会阴侧切切口感染主要致病菌，检出率分别为25.58%和23.26%。54.35%（25/46）产妇存在两种或两种以上病原菌感染。单因素分析结果显示，产妇会阴侧切术后切口感染与产妇BMI、阴道产检次数、胎膜早破、产程、切口长度、助产士工作年限、术后住院时间、妊娠期合并糖尿病、生殖道感染有关（P均< 0.05），而与产妇年龄、是否为初产妇、是否急诊分娩无关（P均> 0.05）。Logistic回归分析结果显示，产妇BMI （OR = 2.282、95%CI：1.958～8.265、P < 0.001）、阴道产检次数（OR = 1.855、95%CI：1.065～4.682、P = 0.002）、胎膜早破（OR = 2.085、95%CI：1.730～7.165、P < 0.001）、生殖道感染（OR = 2.732、95%CI：2.015～10.562、P = 0.015）、妊娠期合并糖尿病（OR = 3.337、95%CI：2.356～12.526、P < 0.001）、产程（OR = 1.714、95%CI：1.305～4.928、P < 0.001）均为产妇会阴侧切切口感染的独立危险因素。 结论受多种因素影响，产妇会阴侧切切口感染发生率较高，大肠埃希菌和表皮葡萄球菌为主要致病菌。临床应对增加切口感染发生率的危险因素采取针对性措施进行干预，以降低会阴侧切术后切口感染的发生。

Pathogenic bacteria distribution and related factors of incision infection after lateral perineal incision of parturients

ObjectiveTo investigate the distribution characteristics of pathogenic bacteria of perineal incision infection in parturients, and to analyze the risk factors of perineal incision infection in parturients, to provide guidance for the prevention and treatment of perineal incision infection. MethodsTotal of 461 parturients who underwent lateral perineal incision in Kaizhou District People’s Hospital from March 2014 to October 2018 were selected for retrospective analysis. According to the results of bacterial culture, the parturients were divided into infection group (46 cases) and uninfected group (415 cases). The types and proportion of pathogenic bacteria in incision infection after lateral perineal incision were analyzed. The risk factors affecting the infection of lateral perineal incision were analyed by Logistic unconditional regression analysis. ResultsThe infection rate of lateral episiotomy incision was 9.98% (46/461). A total of 43 strains were detected. Gram-negative bacteria accounted for 53.49% (23/43), Gram-positive bacteria accounted for 39.53% (17/43). Escherichia coli and Staphylococcus epidermidis were the main pathogens of lateral episiotomy incision infection. The detection rates were 25.58% and 23.26%. There were 54.35% (25/46) of parturients had two or more pathogenic bacteria infection. Univariate analysis showed that maternal BMI, number of vaginal examinations, premature rupture of membranes, labor process, incision length, length of midwives’ working life, hospital stay after operation, gestational diabetes mellitus and genital tract infection were related (all P < 0.05), but not related to maternal age, primipara or emergency delivery (all P > 0.05). Logistic regression analysis showed BMI (OR = 2.282, 95%CI: 1.958-8.265, P < 0.001), number of vaginal examinations (OR = 1.855, 95%CI: 1.065-4.682, P = 0.002), premature rupture of membranes (OR = 2.085, 95%CI: 1.730-7.165, P < 0.001), reproductive tract infection (OR = 2.732, 95%CI: 2.015-10.562, P = 0.015), gestational diabetes mellitus (OR = 3.337, 95%CI: 2.356-12.526、P < 0.001), labor process (OR = 1.714, 95%CI: 1.305-4.928, P < 0.001) were independent risk factors for perineal incision infection. ConclusionsInfection rate of perineal incision is higher in parturients affected by many factors, Escherichia coli and Staphylococcus epidermidis were the main pathogens.Clinical targeted measures should be taken to increase the risk factors of incision infection in order to reduce the rates of incision infection after perineal lateral resection.