延长预防性使用广谱抗生素可降低剖宫产术后子宫内膜炎的发病率

Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis.

作者信息

Tita Alan T N, Hauth John C, Grimes Anne, Owen John, Stamm Alan M, Andrews William W

机构信息

Department of Obstetrics & Gynecology, and Infection Control Unit, UAB Hospital, University of Alabama at Birmingham, Birmingham, Alabama, USA.

出版信息

Obstet Gynecol. 2008 Jan;111(1):51-6. doi: 10.1097/01.AOG.0000295868.43851.39.

DOI:10.1097/01.AOG.0000295868.43851.39

PMID:18165392

Abstract

OBJECTIVE

To describe the effect of an extended-spectrum prophylactic antibiotic regimen on postcesarean endometritis.

METHODS

This is a cohort study of trends in postcesarean endometritis using data both from prospective surveillance by the infection control unit and from query of our obstetric computerized database to compare three periods of antibiotic prophylaxis: standard narrow-spectrum with intravenous first- or second-generation cephalosporin (1992-1996), clinical trial of extended-spectrum with addition of intravenous doxycycline and oral azithromycin (1997-1999), and routine use of extended-spectrum with addition of intravenous azithromycin (2001-2006) to standard cephalosporin prophylaxis.

RESULTS

A total of 48,913 deliveries at 24 weeks or more of gestation occurred from 1992 to 2006, of which 10,966 (22.4%) were cesarean deliveries. Annual cesarean rates increased from 16% to 27.5%. Trends in the incidence of postcesarean endometritis revealed a biphasic decrease consistent with the phased introduction of extended-spectrum prophylaxis. Incidence (95% confidence interval [CI]) of endometritis by prospective surveillance dropped from 19.9% (95% CI 18.6-21.3%) to 15.4% (95% CI 13.2-17.9%) during the clinical trial period: relative risk (RR) 0.77 (95% CI 0.66-0.91), P=.002; and then to 6.3% (95% CI 5.0-7.9%) during routine use of extended-spectrum prophylaxis: RR 0.41 (95% CI 0.31-0.54), P<.001. Corresponding incidence by database query dropped from 23% (95% CI 21.5-24.4%) to 16% (95% CI 14.4-17.9%): RR 0.69 (95% CI 0.61-0.79), P<.001; and then to 2.1% (95% CI 1.8-2.6%): RR 0.13 (95% CI 0.11-0.16), P<.001. These findings were unchanged after adjusting for potential confounders.

CONCLUSION

Extended-spectrum antibiotic prophylaxis involving the addition of azithromycin to standard narrow-spectrum prophylaxis was associated with a significant reduction in postcesarean endometritis.

LEVEL OF EVIDENCE

II.

摘要

目的

描述广谱预防性抗生素方案对剖宫产术后子宫内膜炎的影响。

方法

这是一项关于剖宫产术后子宫内膜炎趋势的队列研究，使用了感染控制部门前瞻性监测的数据以及我们产科计算机数据库的查询数据，以比较三个抗生素预防阶段：使用静脉注射第一代或第二代头孢菌素的标准窄谱抗生素（1992 - 1996年）、添加静脉注射强力霉素和口服阿奇霉素的广谱抗生素临床试验（1997 - 1999年），以及在标准头孢菌素预防基础上常规使用添加静脉注射阿奇霉素的广谱抗生素（2001 - 2006年）。

结果

1992年至2006年期间，共发生48913例孕周24周及以上的分娩，其中10966例（22.4%）为剖宫产。剖宫产年率从16%上升至27.5%。剖宫产术后子宫内膜炎发病率趋势显示出双相下降，这与广谱预防措施的分阶段引入一致。在前瞻性监测中，子宫内膜炎发病率（95%置信区间[CI]）在临床试验期间从19.9%（95%CI 18.6 - 21.3%）降至15.4%（95%CI 13.2 - 17.9%）：相对风险（RR）0.77（95%CI 0.66 - 0.91），P = 0.002；在广谱预防措施常规使用期间进一步降至6.3%（95%CI 5.0 - 7.9%）：RR 0.41（95%CI 0.31 - 0.54），P < 0.001。通过数据库查询得到的相应发病率从23%（95%CI 21.5 - 24.4%）降至%（95%CI 14.4 - 17.9%）：RR 0.69（95%CI 0.61 - 0.79），P < 0.001；然后降至2.1%（95%CI 1.8 - 2.6%）：RR 0.13（95%CI 0.11 - 0.16），P < 0.001。在对潜在混杂因素进行调整后，这些结果不变。