Ahmadzia Homa K, Patel Emily M, Joshi Dipa, Liao Caiyun, Witter Frank, Heine R Phillips, Coleman Jenell S
Departments of Obstetrics and Gynecology, Duke University, Durham, North Carolina, and Johns Hopkins University, Baltimore, Maryland.
Obstet Gynecol. 2015 Oct;126(4):708-715. doi: 10.1097/AOG.0000000000001064.
To estimate whether morbidly obese gravid patients were less likely to develop a surgical site infection after receiving a higher dose of preoperative prophylactic antibiotics.
A retrospective cohort study of morbidly obese pregnant women undergoing cesarean delivery was conducted at two tertiary care centers from 2008 to 2013. Exposure was defined as receiving 2 g compared with 3 g cefazolin preoperatively. Disease was defined by diagnosis of a surgical site infection using Centers for Disease Control and Prevention criteria. We estimated a sample size of 141 patients in each group for a 67% reduction (15% to 5%) in risk for a surgical site infection.
There were 335 women included in the cohort with a median absolute weight of 310 (interquartile range 299-333) pounds. Forty-four (13.1%) women were diagnosed with a surgical site infection. There was no difference in surgical site infection among those women who received 2 g compared with 3 g cefazolin (13.1% [23/175] compared with 13.1% [21/160]; P=.996). Labor (crude odds ratio [OR] 2.31, 95% confidence interval [CI] 1.21-4.40), internal labor monitoring (OR 2.78, 1.45-5.31), blood loss greater than 1,500 mL (OR 2.15, 1.09-5.78), and staple closure (OR 2.2, 1.15-4.21) were associated with a surgical site infection among the entire cohort. After multivariable analysis, blood loss greater than 1,500 mL (adjusted OR 3.32, 1.32-8.37) and staple closure (adjusted OR 2.45, 1.19-5.02) remained associated with an increased risk for a surgical site infection, whereas 3 g cefazolin still was not associated with reduced risk for a surgical site infection (adjusted OR 1.33, 0.64-2.74).
In our multicenter retrospective cohort study, preoperative 3 g cefazolin prophylaxis administered to morbidly obese gravid patients did not reduce surgical site infections.
III.
评估病态肥胖孕妇在接受更高剂量的术前预防性抗生素治疗后发生手术部位感染的可能性是否更低。
2008年至2013年在两家三级医疗中心对接受剖宫产的病态肥胖孕妇进行了一项回顾性队列研究。暴露因素定义为术前接受2克头孢唑林与3克头孢唑林的对比。疾病定义为根据疾病控制与预防中心的标准诊断为手术部位感染。我们估计每组样本量为141例患者，以使手术部位感染风险降低67%（从15%降至5%）。
队列中纳入了335名女性，中位绝对体重为310磅（四分位间距299 - 333磅）。44名（17.1%）女性被诊断为手术部位感染。接受2克头孢唑林与3克头孢唑林的女性在手术部位感染方面无差异（分别为13.1% [23/175]与13.1% [21/160]；P = 0.996）。分娩（粗比值比[OR] 2.31，95%置信区间[CI] 1.21 - 4.40）、产时内部监护（OR 2.78，1.45 - 5.31）、失血大于1500毫升（OR 2.15，1.09 - 5.78）以及钉皮缝合（OR 2.2，1.15 - 4.21）与整个队列中的手术部位感染相关。多变量分析后，失血大于1500毫升（校正OR 3.32，1.32 - 8.37）和钉皮缝合（校正OR 2.45，1.19 - 5.02）仍与手术部位感染风险增加相关，而3克头孢唑林仍与手术部位感染风险降低无关（校正OR 1.33，0.64 - 2.74）。
在我们的多中心回顾性队列研究中，对病态肥胖孕妇术前给予3克头孢唑林预防性用药并未降低手术部位感染的发生率。
III级。
