Kaimal Anjali J, Zlatnik Marya G, Cheng Yvonne W, Thiet Mari-Paule, Connatty Elspeth, Creedy Patricia, Caughey Aaron B
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Am J Obstet Gynecol. 2008 Sep;199(3):310.e1-5. doi: 10.1016/j.ajog.2008.07.009.
The purpose of this study was to examine the effect of a change in policy regarding the timing of antibiotic administration on the rates of postcesarean delivery surgical-site infections (SSI).
This was a retrospective cohort study of 1316 term, singleton cesarean deliveries at 1 institution. A policy change was instituted wherein prophylactic antibiotics were given before skin incision rather than after cord clamp. The primary outcome that was examined was SSI; secondary outcomes were the rates of endometritis and cellulitis. Multivariable regression was performed to control for potential confounders.
The overall rate of SSI fell from 6.4-2.5% (P = .002). When we controlled for potential confounders, there was a decline in overall SSI with an adjusted odds ratio (aOR) of 0.33 (95% CI, 0.14,0.76), a decrease in endometritis (aOR, 0.34; 95% CI, 0.13,0.92), and a trend towards a decrease in cellulitis (aOR, 0.22; 95% CI, 0.05,1.22).
At our institution, a change in policy to administer prophylactic antibiotics before skin incision led to a significant decline in postcesarean delivery SSIs.
本研究旨在探讨剖宫产术后抗生素给药时机政策的改变对手术部位感染（SSI）发生率的影响。
这是一项对某一机构1316例足月单胎剖宫产病例的回顾性队列研究。实施了一项政策改变，即预防性抗生素在皮肤切开前而非脐带钳夹后给药。所研究的主要结局是SSI；次要结局是子宫内膜炎和蜂窝织炎的发生率。进行多变量回归以控制潜在的混杂因素。
SSI的总体发生率从6.4%降至2.5%（P = .002）。当我们控制潜在的混杂因素时，总体SSI有所下降，调整后的优势比（aOR）为0.33（95%可信区间，0.14,0.76），子宫内膜炎有所减少（aOR，0.34；95%可信区间，0.13,0.92），蜂窝织炎有下降趋势（aOR，0.22；95%可信区间，0.05,1.22）。
在我们机构，将预防性抗生素给药时机改为在皮肤切开前给药导致剖宫产术后SSI显著下降。
