剖宫产术后预防性抗生素的选择与手术部位感染。
Choice of Prophylactic Antibiotics and Surgical Site Infections After Cesarean Delivery.
机构信息
Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC; the Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland; and Georgetown-Howard Universities Center for Clinical and Translational Science and Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC.
出版信息
Obstet Gynecol. 2018 Oct;132(4):948-955. doi: 10.1097/AOG.0000000000002863.
OBJECTIVE
To examine the rate of surgical site infection according to the choice of antibiotics in women undergoing cesarean delivery.
METHODS
We conducted a retrospective cohort study of women undergoing cesarean delivery (labored, unlabored, and scheduled) from 2012 to 2017. Women with chorioamnionitis and those who did not receive any antibiotics were excluded. Our primary outcome was defined a priori as a composite of cellulitis, endometritis, deep wound infection, abdominopelvic abscess, and sepsis. Outcomes were examined according to the choice of antibiotics: cefazolin, a standard alternative (both clindamycin and gentamicin), and inappropriate alternatives (such as clindamycin only). A multivariable logistic regression model was used to calculate the propensity score for each observation, which was the probability of receiving a particular antibiotic regimen. The propensity score-adjusted logistic regression models were conducted to calculate adjusted odds ratios (ORs) and 95% CIs. Firth's penalized likelihood approach was applied to address issues of rare events.
RESULTS
Among 6,584 selected women, 6,163 (93.6%), 274 (4.2%), and 147 (2.2%) received cefazolin, a standard alternative, and inappropriate alternatives, respectively. Use of standard alternative antibiotics compared with cefazolin was not associated with increased odds of the primary outcome (crude OR 1.50 [0.92-2.46]; adjusted OR 1.63 [0.97-2.60]) but was associated with increased odds of cellulitis (crude OR 2.07 [1.16-3.70]; adjusted OR 1.93 [1.03-3.31]). Use of inappropriate alternative antibiotics compared with cefazolin was associated with increased odds of the primary outcome (crude OR 4.37 [2.80-6.83]; adjusted OR 4.13 [2.59-6.36]) as well as some components of the composite outcome such as endometritis before discharge (crude OR 6.85 [3.94-11.90]; adjusted OR 6.68 [3.69-11.44]) and cellulitis (crude OR 3.36 [1.78-6.34]; adjusted OR 3.23 [1.63-5.81]).
CONCLUSION
Both standard alternative and inappropriate alternatives were associated with increased odds of surgical site infections compared with cefazolin.
目的
研究剖宫产产妇根据抗生素选择的手术部位感染率。
方法
我们对 2012 年至 2017 年行剖宫产术（有产程、无产程和择期）的妇女进行了回顾性队列研究。排除患有绒毛膜羊膜炎和未使用任何抗生素的妇女。我们的主要结局是预先定义的复合结果，包括蜂窝织炎、子宫内膜炎、深部伤口感染、腹盆腔脓肿和败血症。根据抗生素的选择来检查结局：头孢唑林，一种标准替代药物（克林霉素和庆大霉素均为替代药物），以及不适当的替代药物（如仅使用克林霉素）。使用多变量逻辑回归模型计算每个观察值的倾向评分，即接受特定抗生素方案的概率。使用倾向评分调整的逻辑回归模型计算调整后的优势比（OR）和 95%置信区间（CI）。采用 Firth 惩罚似然法解决罕见事件问题。
结果
在 6584 名入选妇女中，分别有 6163 名（93.6%）、274 名（4.2%）和 147 名（2.2%）妇女接受了头孢唑林、标准替代药物和不适当的替代药物。与头孢唑林相比，使用标准替代抗生素并不会增加主要结局的发生几率（粗 OR 1.50[0.92-2.46]；调整 OR 1.63[0.97-2.60]），但与蜂窝织炎的发生几率增加有关（粗 OR 2.07[1.16-3.70]；调整 OR 1.93[1.03-3.31]）。与头孢唑林相比，使用不适当的替代抗生素与主要结局的发生几率增加有关（粗 OR 4.37[2.80-6.83]；调整 OR 4.13[2.59-6.36]），也与复合结局的一些组成部分有关，如出院前的子宫内膜炎（粗 OR 6.85[3.94-11.90]；调整 OR 6.68[3.69-11.44]）和蜂窝织炎（粗 OR 3.36[1.78-6.34]；调整 OR 3.23[1.63-5.81]）。
结论
与头孢唑林相比，标准替代药物和不适当的替代药物均与手术部位感染几率增加有关。
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