Griffiths Jill, Demianczuk Nestor, Cordoviz Melody, Joffe A Mark
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton AB.
J Obstet Gynaecol Can. 2005 Apr;27(4):340-4. doi: 10.1016/s1701-2163(16)30460-1.
To ascertain the incidence of postoperative surgical site infection (SSI) following elective Caesarean section (CS) and to compare demographic characteristics and antibiotic administration between infected cases and noninfected control subjects.
We conducted a retrospective case-control study of patients undergoing elective CS between 1996 and 2002 at a tertiary centre. Infection-control personnel attempted to contact by telephone all women who had had Caesarean sections, 1 month after their surgery. The women they reached were asked to complete a questionnaire based on CDC-validated criteria for infection to determine whether SSI had occurred. Control subjects without SSI were matched on the basis of having had an elective CS and by date of surgery. We then reviewed the hospital records of both groups.
Over the study period, 1250 elective Caesarean sections were performed and 124 infected cases were identified, giving an overall SSI incidence of 9.9%. Of the 342 women reviewed (124 cases, 218 control subjects), 23% received prophylactic intraoperative antibiotics. Cases and control subjects differed significantly in terms of estimated blood loss, with fewer control subjects having excessive blood loss (P = 0.04). Among those women receiving postoperative antibiotics, case subjects received a significantly higher number of doses than did control subjects (P = 0.003). The groups did not differ significantly in terms of overall antibiotic administration or other demographic variables.
The incidence of SSI following elective CS according to postdischarge surveillance was 9.9%, which is higher than expected for a low-risk procedure. Because follow-up was not possible for all cases, this incidence may be an underestimate. Underuse of antimicrobial prophylaxis may also be a contributing factor, because prophylactic antibiotics were administered in less than 25% of cases.
确定择期剖宫产术后手术部位感染（SSI）的发生率，并比较感染病例与未感染对照者的人口统计学特征及抗生素使用情况。
我们对1996年至2002年在一家三级医疗中心接受择期剖宫产的患者进行了一项回顾性病例对照研究。感染控制人员在术后1个月试图通过电话联系所有接受剖宫产的女性。与他们取得联系的女性被要求根据疾病预防控制中心（CDC）验证的感染标准填写一份问卷，以确定是否发生了SSI。无SSI的对照者根据接受择期剖宫产及手术日期进行匹配。然后我们查阅了两组的医院记录。
在研究期间，共进行了1250例择期剖宫产，确定了124例感染病例，总体SSI发生率为9.9%。在接受评估的342名女性（124例病例，218名对照者）中，23%的患者术中接受了预防性抗生素治疗。病例组和对照组在估计失血量方面存在显著差异，对照组中失血过多的患者较少（P = 0.04）。在接受术后抗生素治疗的女性中，病例组接受的剂量显著高于对照组（P = 0.003）。两组在总体抗生素使用或其他人口统计学变量方面没有显著差异。
根据出院后监测，择期剖宫产术后SSI的发生率为9.9%，高于低风险手术的预期发生率。由于并非所有病例都能进行随访，这一发生率可能被低估。抗菌预防措施使用不足也可能是一个促成因素，因为不到25%的病例使用了预防性抗生素。
