Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis.
Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis.
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DOI：
10.1097/aog.0000000000001899
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发表时间：
2017-03
影响因子：
7.2
通讯作者：
Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium
中科院分区：
文献类型：
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作者：
Boggess KA;Tita A;Jauk V;Saade G;Longo S;Clark EAS;Esplin S;Cleary K;Wapner R;Letson K;Owens M;Blackwell S;Beamon C;Szychowski JM;Andrews W;Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium
在一项切口前广谱抗生素预防的随机临床试验中，确定剖宫产后产妇感染的临床危险因素。我们对一项随机临床试验进行了有计划的二次分析。患者妊娠≥24周，经至少4小时胎膜破裂或阵痛后剖宫产分娩。所有的参与者都接受了标准的切口前预防，并随机接受阿奇霉素或安慰剂。本分析的主要结局是母体感染：产后6周内发生子宫内膜炎、伤口感染（浅表或深部）或其他感染的复合结局。在控制阿奇霉素分配后，确定了与母体感染相关的母体临床特征。将这些母体因素纳入母体感染的多变量logistic回归模型。在2013名患者中，1019名随机接受阿奇霉素治疗。总体而言，177例（8.8%）发生剖宫产后母体感染。在最终调整后的模型中，与参照组相比，非横向子宫切口、膜破裂持续时间bbbb6小时、手术持续时间bbbb49分钟的黑人妇女，其母体感染的几率更高（所有调整后的优势比均为~ 2）；阿奇霉素与母体感染几率较低相关（校正优势比为0.4,95%可信区间为0.3-0.6）。尽管在切开前使用阿奇霉素为基础的广谱抗生素预防，剖宫产后产妇感染仍然是发病率的重要来源。认识到风险因素可能有助于指导创新的预防战略。
To identify maternal clinical risk factors for postcesarean maternal infection in a randomized clinical trial of preincision extended-spectrum antibiotic prophylaxis. We conducted a planned secondary analysis of a randomized clinical trial. Patients were ≥ 24 weeks of gestation and delivered by cesarean delivery after a minimum of 4 hours of ruptured membranes or labor. All participants received standard preincision prophylaxis and were randomized to receive azithromycin or placebo. The primary outcome for this analysis is maternal infection: a composite outcome of endometritis, wound infection (superficial or deep), or other infections occurring up to 6 weeks postpartum. Maternal clinical characteristics associated with maternal infection, after controlling for azithromycin assignment, were identified. These maternal factors were included in a multivariable logistic regression model for maternal infection. Of 2,013 patients, 1,019 were randomized to azithromycin. Overall, 177 (8.8%) had postcesarean maternal infection. In the final adjusted model, compared to the reference groups, women of Black race–ethnicity, with a nontransverse uterine incision, with duration of membrane rupture > 6 hours, and surgery duration > 49 minutes, were associated higher odds of maternal infection (all with adjusted odds ratios of ∼2); azithromycin was associated with lower odds of maternal infection (adjusted odds ratio of 0.4, 95% confidence interval 0.3-0.6. Despite preincision azithromycin-based extended spectrum antibiotic prophylaxis, postcesarean maternal infection remains a significant source of morbidity. Recognition of risk factors may help guide innovative prevention strategies.