Salmanov Aidyn G, Vitiuk Alla D, Zhelezov Dmytro, Bilokon Olga, Kornatska Alla G, Dyndar Olena A, Trokhymovych Olha V, Bozhko Nataliia, Raksha Iryna I, Nykoniuk Tetiana R, Gorbunova Olga V, Kokhanov Igor V, Kushnirenko Stella, Iarotska Iryna, Golianovsky Oleg V, Holovanova Iryna A, Abbasova Esmira R
Shupyk National Medical Academy Of Postgraduate Education, Kyiv, Ukraine.
Odesa National Medical University, Odesa, Ukraine.
Wiad Lek. 2020;73(6):1177-1183.
The aim: To obtain the prevalence of postpartum endometritis women and antimicrobial resistance of responsible pathogens in Ukraine.
Materials and methods: We performed a retrospective multicenter cohort study. The study population consisted of all women who had a vaginal delivery or cesarean section in 14 Regional Women's Hospitals of Ukraine.
Results: Total 2460 of 25,344 patients were found to have postpartum endometritis, for an overall infection rate of 9.7%. The postpartum endometritis rates were 7.6% after vaginal delivery and 16.4% after cesarean section. Incidence of postpartum endometritis after cesarean section is affected mainly by the mode of delivery (scheduled caesarean deliveries (done before labor starts) - 13.8% and unscheduled caesarean deliveries (done after labor starts) - 22.5%. The predominant pathogens were: Escherichia coli (32.7%), Enterococcus faecalis (13.0%), Streptococcus spp. (12.1%), Klebsiella spp. (10.4%) and Enterobacter spp. (10%). Among the antimicrobial agents tested, the ertapenem, piperacillin/tazobactam, and cefotaxim were the most consistently active in vitro against Enterobacteriaceae in both vaginal deliveries and after cesarean section infections. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 22.8% and of methicillin-resistance in Staphylococcus aureus (MRSA) 15.4%.
Conclusions: Postpartum endometritis and antimicrobial resistance of responsible pathogens presents a significant burden to the hospital system. Postpartum infections surveillance is required in all women's hospitals. This knowledge is essential to develop targeted strategies to reduce the incidence of postpartum infections.
本研究旨在获取乌克兰产后子宫内膜炎女性的患病率以及致病病原体的抗菌耐药性。
我们开展了一项回顾性多中心队列研究。研究人群包括在乌克兰14家地区妇产医院进行阴道分娩或剖宫产的所有女性。
在25344例患者中，共有2460例被发现患有产后子宫内膜炎，总体感染率为9.7%。阴道分娩后的产后子宫内膜炎发生率为7.6%，剖宫产术后为16.4%。剖宫产术后产后子宫内膜炎的发生率主要受分娩方式影响（计划性剖宫产（在临产开始前进行）-13.8%，非计划性剖宫产（在临产开始后进行）-22.5%）。主要病原体为：大肠埃希菌（32.7%）、粪肠球菌（13.0%）、链球菌属（12.1%）、克雷伯菌属（10.4%）和肠杆菌属（10%）。在所测试的抗菌药物中，厄他培南、哌拉西林/他唑巴坦和头孢噻肟在体外对阴道分娩和剖宫产术后感染的肠杆菌科细菌最具活性且始终有效。肠杆菌科细菌中产超广谱β-内酰胺酶（ESBL）的总体比例为22.8%，金黄色葡萄球菌中甲氧西林耐药（MRSA）的比例为15.4%。
产后子宫内膜炎及致病病原体的抗菌耐药性给医院系统带来了沉重负担。所有妇产医院都需要进行产后感染监测。这些知识对于制定针对性策略以降低产后感染发生率至关重要。
