Assawapalanggool Srisuda, Kasatpibal Nongyao, Sirichotiyakul Supatra, Arora Rajin, Suntornlimsiri Watcharin
Infection Control Section, Maesot Hospital, Tak, Thailand.
Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
Am J Infect Control. 2016 Sep 1;44(9):990-5. doi: 10.1016/j.ajic.2016.01.031. Epub 2016 Mar 11.
Cesarean surgical site infections (SSIs) are a major challenge in Thai-Myanmar border hospital settings. This study aimed to examine risk factors for SSIs after cesarean section.
This was a prospective cohort study conducted in a Thai-Myanmar border hospital between January 2007 and December 2012. Data were collected from the medical record database by trained infection control nurses. Stepwise multivariable logistic regression was used for risk factor analysis and expressed as a risk ratio (RR).
The cesarean SSI rate was 5.9% (293 SSIs in 4,988 cases). Of these, 17.1% were incisional SSIs (10.9% superficial and 6.2% deep incisional SSIs), and 82.9% were organ or space SSIs. Risk factors for cesarean organ-space SSIs included a wound class ≥3 (RR, 4.82; 95% confidence interval [CI], 3.41-6.83), ethnic minority (RR, 2.51; 95% CI, 1.61-3.92), hemoglobin <11 g/dL (RR, 2.19; 95% CI, 1.57-3.04), pelvic examination before delivery on ≥5 occasions (RR, 4.16; 95% CI, 2.89-5.99), preterm (RR, 1.98; 95% CI, 1.33-2.95), being a local referral (RR, 3.37; 95% CI, 2.29-4.97), and foul-smelling amniotic fluid (RR, 21.08; 95% CI, 10.23-43.41).
Most cesarean SSIs in this study seem to have a high severity. Their risk factors reflected delayed appropriate perinatal maternal care that resulted in late cesarean delivery. Early prenatal care may help reduce cesarean SSIs among this population.
剖宫产手术部位感染（SSIs）是泰缅边境医院面临的一项重大挑战。本研究旨在探讨剖宫产术后手术部位感染的危险因素。
这是一项前瞻性队列研究，于2007年1月至2012年12月在一家泰缅边境医院开展。数据由经过培训的感染控制护士从病历数据库中收集。采用逐步多变量逻辑回归进行危险因素分析，并以风险比（RR）表示。
剖宫产手术部位感染率为5.9%（4988例中有293例发生手术部位感染）。其中，17.1%为切口感染（10.9%为浅表切口感染，6.2%为深部切口感染），82.9%为器官或腔隙感染。剖宫产器官-腔隙感染的危险因素包括伤口分级≥3级（RR，4.82；95%置信区间[CI]，3.41-6.83）、少数民族（RR，2.51；95%CI，1.61-3.92）、血红蛋白<11g/dL（RR，2.19；95%CI，1.57-3.04）、分娩前盆腔检查≥5次（RR，4.16；95%CI，2.89-5.99）、早产（RR，1.98；95%CI，1.33-2.95）、为本地转诊患者（RR，3.37；95%CI，2.29-4.97）以及羊水有异味（RR，21.08；95%CI，10.23-43.41）。
本研究中的大多数剖宫产手术部位感染似乎严重程度较高。其危险因素反映出围产期孕产妇护理不及时，导致剖宫产延迟。早期产前护理可能有助于降低该人群的剖宫产手术部位感染率。
