Barbut F, Carbonne B, Truchot F, Spielvogel C, Jannet D, Goderel I, Lejeune V, Milliez J
Unité d'Hygiène et de Lutte contre les Infections Nosocomiales (UHLIN), France.
J Gynecol Obstet Biol Reprod (Paris). 2004 Oct;33(6 Pt 1):487-96. doi: 10.1016/s0368-2315(04)96561-1.
To determine the incidence of surgical site infections and to identify risk factors for infections.
A prospective study of surgical site infections (SSI) after cesarean section was carried out from September 1997 to September 1998 (pilot study) and from January 2000 to August 2003, using the methodology of the American National Nosocomial Infection Surveillance System. Follow up of women was performed by midwives until discharge and during the post-natal visit. Suspected surgical site infections were confirmed by surgeons and infection control practitioners. The microbiological file of each patient was edited 30 days after cesarean section. Risk factors were analyzed using a logistic regression model.
During the pilot study, infection rate was estimated at 3.2%. At multivariate analysis, factors independently associated with an increased risk of SSI were ASA score > 1, performance of cesarean section in a room not dedicated to this activity, and use of an open urine drainage system. During the following years (2000-2003), infection rates progressively decreased to reach 1.9% in 2003. Infections included superficial wound infections (involving skin and subcutaneous tissue) (47%), deep wound infections (involving deep and soft tissue (fascia and muscle) (20%) and organ/space infections (i.e. endometritis, pelvic abscess) (33%). Infections occurred after patient discharge in 47.5% of cases and diagnosis was based only on clinical findings in 30% of cases. Infected patients were hospitalized longer (median: 6 days) than non infected patients.
Prospective surveillance of SSI led to better awareness of infectious problems among health care workers, to identification of risk factors and evaluation of health procedures. Surveillance contributed to a decrease in nosocomial infections.
确定手术部位感染的发生率，并识别感染的危险因素。
采用美国国家医院感染监测系统的方法，于1997年9月至1998年9月（试点研究）以及2000年1月至2003年8月对剖宫产术后手术部位感染（SSI）进行了前瞻性研究。由助产士对产妇进行随访直至出院以及产后访视期间。疑似手术部位感染由外科医生和感染控制人员确诊。每位患者的微生物学档案在剖宫产术后30天编辑。使用逻辑回归模型分析危险因素。
在试点研究期间，感染率估计为3.2%。多因素分析显示，与SSI风险增加独立相关的因素为美国麻醉医师协会（ASA）评分>1、在非专用手术室进行剖宫产以及使用开放式尿液引流系统。在随后几年（2000 - 2003年），感染率逐渐下降，2003年降至1.9%。感染包括浅表伤口感染（涉及皮肤和皮下组织）（47%）、深部伤口感染（涉及深部和软组织（筋膜和肌肉）（20%）以及器官/腔隙感染（即子宫内膜炎、盆腔脓肿）（33%）。47.5%的感染病例发生在患者出院后，30%的病例仅基于临床发现进行诊断。感染患者的住院时间（中位数：6天）比未感染患者更长。
对SSI进行前瞻性监测提高了医护人员对感染问题的认识，有助于识别危险因素并评估医疗程序。监测有助于降低医院感染率。
