Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.
NewYork-Presbyterian Value Institute, New York, New York.
Am J Perinatol. 2024 May;41(S 01):e520-e527. doi: 10.1055/a-1904-9583. Epub 2022 Jul 20.
Our objective was to determine modifiable risk factors associated with surgical site infection (SSI) and postpartum endometritis. We hypothesized that inappropriate surgical antibiotic prophylaxis would be a risk factor for both types of infections.
This was a single-center case-control study of SSI and endometritis after cesarean delivery over a 2-year period from 2016 to 2017. Cases were identified by International Classification of Diseases, 10th Revision diagnosis codes, infection control surveillance, and electronic medical records search and were subsequently confirmed by chart review. Three controls were randomly selected for each case from all cesareans ± 48 hours from case delivery. Demographic, pregnancy, and delivery characteristics were abstracted. Separate multivariable logistic regression models were used to assess factors associated with SSI and endometritis. Postpartum outcomes, including length of stay and readmission, were also compared.
We identified 141 cases of SSI and endometritis with an overall postpartum infection rate of 4.0% among all cesarean deliveries. In adjusted analysis, factors associated with both SSI and endometritis were intrapartum delivery, classical or other (non-low-transverse) uterine incision, and blood transfusion. Factors associated with SSI only included inadequate antibiotic prophylaxis, public insurance, hypertensive disorder of pregnancy, and nonchlorhexidine abdominal preparation; factors only associated with endometritis included β-lactam allergy, anticoagulation therapy, and chorioamnionitis. Among cases, 34% of those with SSI and 25% of those with endometritis did not receive adequate antibiotic prophylaxis, compared with 12.9 and 13.5% in control groups, respectively. Failure to receive appropriate antibiotic prophylaxis was associated with an increased risk of SSI (adjusted odds ratio [aOR]: 4.4, 95% confidence interval [CI]: 1.3-15.6) but not endometritis (aOR 0.9, 95% CI 0.4-2.0).
Inadequate surgical antibiotic prophylaxis was associated with an increased risk of SSI but not postpartum endometritis, highlighting the different mechanisms of these infections and the importance of prioritizing adequate surgical prophylaxis. Additional potentially modifiable factors which emerged included blood transfusion and chlorhexidine skin preparation.
· Inadequate antibiotic prophylaxis is associated with a four-fold risk in surgical site infections.. · The most common cause for failure to achieve adequate surgical prophylaxis was inappropriate timing of antibiotics at or after skin incision.. · Blood transfusions are strongly associated (>10-fold risk) with both SSI and endometritis..
我们旨在确定与手术部位感染（SSI）和产后子宫内膜炎相关的可改变的危险因素。我们假设不适当的外科抗生素预防措施将是这两种感染的危险因素。
这是一项单中心病例对照研究，对 2016 年至 2017 年期间 2 年内的剖宫产术后 SSI 和子宫内膜炎进行研究。通过国际疾病分类，第 10 版诊断代码、感染控制监测以及电子病历搜索确定病例，并通过图表审查进行后续确认。从每个病例的所有剖宫产术±48 小时内随机选择 3 名对照。提取人口统计学、妊娠和分娩特征。使用单独的多变量逻辑回归模型评估与 SSI 和子宫内膜炎相关的因素。还比较了产后结局，包括住院时间和再入院率。
我们共发现 141 例 SSI 和子宫内膜炎病例，所有剖宫产术后的总体产后感染率为 4.0%。在调整分析中，与 SSI 和子宫内膜炎均相关的因素包括分娩期间、经典或其他（非低横向）子宫切口以及输血。仅与 SSI 相关的因素包括抗生素预防措施不足、公共保险、妊娠高血压疾病和绒毛膜羊膜炎；仅与子宫内膜炎相关的因素包括β-内酰胺过敏、抗凝治疗和绒毛膜羊膜炎。在病例中，34%的 SSI 患者和 25%的子宫内膜炎患者未接受足够的抗生素预防，而对照组中分别为 12.9%和 13.5%。未接受适当抗生素预防与 SSI 风险增加相关（调整后的优势比[aOR]：4.4，95%置信区间[CI]：1.3-15.6），但与子宫内膜炎无关（aOR 0.9，95%CI 0.4-2.0）。
不适当的外科抗生素预防措施与 SSI 风险增加相关，但与产后子宫内膜炎无关，这突出了这些感染的不同机制以及优先考虑适当外科预防措施的重要性。出现的其他潜在可改变的因素包括输血和洗必泰皮肤准备。
