Risk factors for surgical site infection after low transverse cesarean section
Risk factors for surgical site infection after low transverse cesarean section
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DOI：
10.1086/587810
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发表时间：
2008-06-01
影响因子：
4.5
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
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作者：
Olsen, Margaret A.;Butler, Anne M.;Fraser, Victoria J.
背景剖宫产术后手术部位感染（SSI）的独立危险因素尚未得到充分的记录，尽管大量的剖宫产手术和SSI的相对常见的发生率。确定低位横切口剖宫产术后SSI的独立危险因素。回顾性病例对照研究。巴恩斯犹太医院，一家拥有1,250张床位的三级护理医院。1999年7月~ 2001年6月，对1,605例低位横式剖宫产术的产妇进行回顾性分析。使用国际疾病分类第九次修订版，SSI或伤口并发症的临床修改诊断代码和/或手术住院期间或再次入院或急诊时的抗生素使用数据，我们在接受低位横切口剖宫产术的患者队列中确定了SSI的潜在病例。SSI病例通过使用疾病控制和预防中心国家医院感染监测系统的定义进行图表审查进行验证。对照组无SSI或子宫内膜炎的患者从接受剖宫产术的患者人群中随机选择。SSI的独立危险因素通过logistic回归确定。在1,605名接受低位横切口剖宫产的妇女中，有81名（5.0%）发现了SSI。SSI的独立风险因素包括术后皮下血肿的发生（校正比值比[aOR]，11.6 [95%置信区间{CI}，4.1-33.2]），由大学教学服务机构进行手术（aOR，2.7 [95% CI，1.4-5.2]），入院时体重指数较高（aOR，1.1 [95% CI，1.0-1.1]）。术前或术后头孢菌素治疗与SSI风险显著降低相关（aOR，0.2 [95% CI，0.1-0.5]）。使用斯台普斯闭合皮肤与SSI风险略微增加相关。这些独立的风险因素应纳入预防和监测手术后SSI的方法中。
BACKGROUND. Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.OBJECTIVE. To determine independent risk factors for SSI after low transverse cesarean section.DESIGN. Retrospective case-control study.SETTING. Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.PATIENTS. A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.METHODS. Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.RESULTS. SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1-33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4-5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0-1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1-0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.CONCLUSIONS. These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.