Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark.
Acta Obstet Gynecol Scand. 2011 May;90(5):501-9. doi: 10.1111/j.1600-0412.2011.01090.x. Epub 2011 Mar 14.
To assess the impact of obesity and diabetes on the risk of post-cesarean infections.
Prospective cohort study.
Obstetric departments at three hospitals in Denmark.
2,492 consecutive women having cesarean section (CS) from February 2007 to August 2008.
We collected complete data from medical records and databases on CS, body mass index, diabetes (type 1, type 2, and gestational), and post-cesarean infections. Post-discharge infections diagnosed by general practitioners were ascertained through positive microbiological cultures and antibiotic prescriptions.
Cumulative incidences of infections within 30 days after CS.
Of 2,492 women having CS, 373 (15.2%) were obese and 123 (4.9%) had diabetes. Overall, 458 women (18.4%) had a post-cesarean infection within 30 days and 174 (7.0%) were diagnosed in-hospital. The risk of post-cesarean infections was higher among obese than non-obese women: adjusted (for diabetes and emergency/elective CS) odds ratio (OR)=1.43; 95% confidence interval (CI): 1.09-1.88, particularly for in-hospital infections (OR=1.86; 95%CI: 1.28-2.72). After controlling for obesity and mode of CS, type 2 or gestational diabetes were weak predictors of infection risk (OR=1.18; 95%CI: 0.72-1.93), whereas the adjusted OR in women with type 1 diabetes was 1.65 (95%CI: 0.64-4.25). Among diabetic women, obesity increased the risk of post-cesarean infections more than twofold; the adjusted ORs were 2.06 (95%CI: 1.13-3.75) for infections overall and 2.74 (95%CI: 1.25-6.01) for in-hospital infections.
Obesity increases the risk of post-cesarean infections and diabetes further strengthens this association.
评估肥胖和糖尿病对剖宫产后感染风险的影响。
前瞻性队列研究。
丹麦三家医院的产科病房。
2007 年 2 月至 2008 年 8 月期间 2492 例连续行剖宫产术的妇女。
我们从病历和剖宫产术、体重指数、糖尿病（1 型、2 型和妊娠期）和剖宫产后感染数据库中收集了完整的数据。通过阳性微生物培养和抗生素处方确定出院后由全科医生诊断的感染。
剖宫产术后 30 天内感染的累积发生率。
在 2492 例行剖宫产术的妇女中，373 例（15.2%）肥胖，123 例（4.9%）患有糖尿病。总体而言，458 例（18.4%）妇女在 30 天内发生剖宫产后感染，174 例（7.0%）在院内确诊。与非肥胖妇女相比，肥胖妇女剖宫产后感染的风险更高：调整（糖尿病和紧急/选择性剖宫产术）比值比（OR）=1.43；95%置信区间（CI）：1.09-1.88，尤其是院内感染（OR=1.86；95%CI：1.28-2.72）。在控制肥胖和剖宫产术方式后，2 型或妊娠期糖尿病是感染风险的弱预测因子（OR=1.18；95%CI：0.72-1.93），而 1 型糖尿病妇女的调整后 OR 为 1.65（95%CI：0.64-4.25）。在糖尿病妇女中，肥胖使剖宫产后感染的风险增加了两倍以上；总的感染调整后的 OR 为 2.06（95%CI：1.13-3.75），而院内感染的调整后的 OR 为 2.74（95%CI：1.25-6.01）。
肥胖增加了剖宫产后感染的风险，而糖尿病进一步加强了这种关联。
