摘要
目的:调查产科住院孕妇医院内感染的现状,并分析其影响因素及防治对策。方法:收集2014年1月至2017年12月期间医院产科住院的15828例孕妇的临床资料,均定期入院产检,统计其医院内感染发生率及其感染发生的具体部位,并进行菌株鉴定及药敏试验。同时,收集和分析所有孕产妇的相关临床资料,包括基本资料、检查结果、住院情况、分娩方式、并发症等,分析影响孕妇医院内感染的危险因素。结果:在15828例孕产妇中,171例(1.08%)发生医院内感染,其中82例(47.95%)于住院7~14 d内发生,感染部位以上呼吸道、泌尿生殖系统及手术切口为主,占全部感染的80.70%。所检标本中共分离出54株病原菌,以大肠埃希菌、肺炎克雷伯菌与铜绿假单胞菌最为常见,占全部病原菌的83.33%;上呼吸道病原菌主要为肺炎克雷伯菌,泌尿生殖系统、消化系统、下呼吸道及皮肤黏膜组织病原菌主要为大肠埃希菌。171例医院内感染孕产妇中抗菌药物使用率为89.47%,其中二联用药占44.44%,三联用药占14.04%,抗菌药物平均治疗时间(9.13±2.09)d;主要病原菌对亚胺培南、庆大霉素耐药率低,但是对头孢唑林、头孢他啶、头孢吡肟具有较高的耐药率。单因素分析显示,贫血、产科住院时间≥7d、阴道检查≥3次、有妊娠并发症、平均探视人数≥7人/d、产程延长、产后出血、剖宫产、发生子宫肌瘤及瘢痕子宫的孕产妇感染率明显较高(P<0.05)。Logistic回归分析显示住院时间、阴道检查次数、妊娠并发症、平均每日探视人数、产程延长、产后出血、剖宫产及瘢痕子宫是产科发生医院内感染的独立危险因素(P<0.05)。结论:住院孕妇医院上呼吸道、泌尿生殖系统等部位感染发生率高,以革兰阴性菌为主,且各部位感染优势菌有所不同。住院时间、阴道检查次数、妊娠并发症、平均每日探视人数、产程延长等均可增加感染风险,临床应制订针对性预防措施,并对感染者选取合理抗菌药物治疗。
Objective:To investigate the status of nosocomial infection in obstetric hospitalized pregnant women,and analyze the influencing factors and control measures.Methods:The clinical data of 15828 pregnant women who were hospitalized in the department of obstetrics and gynecology in the hospital during the period from January 2014 to December 2017 were collected.All of them received regular antenatal examination.The incidence of nosocomial infection and the specific location of the infection were analyzed.The strain identification and drug sensitivity test were carried out.The related clinical data of all pregnant and lying-in women were collected and analyzed,including basic information,examination,hospitalization,childbirth and complications,etc.The risk factors for nosocomial infection were analyzed to formulate control measures.Results:Among the 15828 cases,there were 171 cases(1.08%)with nosocomial infection,including 82 cases(47.95%)occurring within 7–14 d of hospitalization.Upper respiratory tract,genitourinary system and surgical incision were main infection sites,accounting for 80.70%of all infections.A total of 54 strains of pathogens were isolated from the samples.Escherichia coli,Klebsiella pneumoniae,and pseudomonas aeruginosa were the most common pathogens,accounting for 83.33%of all pathogens.Main pathogens in upper respiratory tract were Klebsiella pneumoniae,while main pathogens in genitourinary system,digestive system,lower respiratory tract and skin and mucosa tissue were Escherichia coli.Among 171 pregnant women with nosocomial infection,the use rate of antibacterial drugs was 89.47%,of which 44.44%were combined use and 14.04%were triple drug use.The average treatment time of antibiotics was(9.13±2.09)d;the drug resistance rates of main pathogens to imipenem and gentamicin were low,while the drug resistance rates to cefazolin,ceftazidime and cefepime were relatively high.Univariate analysis showed that the infection rate was significantly higher in women with hospital stay≥7 d,vaginal examination≥3 times,with pregnancy complications,the average number of visiting people≥7/d,prolonged labor,postpartum hemorrhage,cesarean section,with uterine fibroids and scarred uterus(P<0.05).Logistic regression model confirmed that the length of hospital stay,frequency of vaginal examination,pregnancy complications,the average number of visiting people per day,prolonged labor,postpartum hemorrhage,anemia,cesarean section and scarred uterus were risk factors for nosocomial infection in obstetrics(P<0.05).Conclusion:The infection rates of upper respiratory tract and genitourinary system of hospitalized pregnant women are high,and gram-negative bacteria are main pathogens,with differences in dominant bacteria in different regions of infection.The length of hospital stay,frequency of vaginal examination,pregnancy complications,the average number of visiting people per day and prolonged labor can increase the risk of infection.In clinical practice,control measures should be developed and the reasonable antimicrobial agents should be chosen for treatment.
作者
姚勤
YAO Qin(Department of Obstetrics and Gynecology,Zhengzhou Maternal and Child Health Care Hospital,Zhengzhou 450000,China)
出处
《临床与病理杂志》
CAS
2021年第2期270-276,共7页
Journal of Clinical and Pathological Research
关键词
产科
住院
孕妇
医院内感染
危险因素
防治
obstetrics
hospitalization
pregnant women
nosocomial infection
risk factors
control
