Wen Yanqing, Ming Xin, Yang Jing, Qi Hongbo
Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Obstetrics and Gynecology, Chongqing Health Center of Women and Children, Chongqing, China.
Front Cell Infect Microbiol. 2024 Dec 12;14:1464485. doi: 10.3389/fcimb.2024.1464485. eCollection 2024.
Puerperal infection (PI) accounting for approximately 11% of maternal deaths globally is an important preventable cause of maternal morbidity and mortality. This study aims to analyze the high-risk factors and pathogenic bacteria of PI, design a nomogram to predict the risk of PI occurrence, and provide clinical guidance for prevention and treatment to improve maternal outcomes.
A total of 525 pregnant women were included in the study. The mothers were randomly divided into a training cohort (n=367) and a test cohort (n=158). The performance of our model was assessed using the area under the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. All the women in the group of PI underwent blood culture tests, if the bacteria were detected, drug sensitivity tests were performed. The drug sensitivity spectrum was recorded and analyzed.
Univariate analysis showed that 12 indicators were significantly different (P < 0.05). Logistic regression analysis showed 6 factors, such as parity, number of vaginal examinations, amount of postpartum bleeding, antibiotics administered in one week before admission, induced labor, and indwelling catheter were significantly different between the PI group and control group (P < 0.05). The area under the ROC curve was 0.904 (95% CI: 0.871-0.936) in the training set and 0.890 (95% CI: 0.837-0.942) in the test set. The calibration curve of the nomogram showed good agreement between prediction and observation. The analysis of the clinical decision curve showed that the nomogram is of practical significance. There were 100 patients with positive blood cultures in the PI group, and was the main pathogenic bacteria, accounting for 89%. The sensitivity to Meropenem and Imipenem was 100%, to Piperacillin tazobactam 97.75%, to Ceftazidime 95.51%, and to Amoxicillin/Clavulanat (AMC) was 93.26%.
The risk of PI will be significantly reduced by controlling the number of vaginal examinations less than 4 times, postpartum hemorrhage less than 414ml, and reducing the time of urethral catheter indwelling. If PI was clinically diagnosed or highly suspected, it was recommended to use antibiotics that were sensitive to , such as Piperacillin tazobactam, Ceftazidime, and AMC.
产褥感染（PI）约占全球孕产妇死亡的11%，是孕产妇发病和死亡的重要可预防原因。本研究旨在分析PI的高危因素和病原菌，设计列线图预测PI发生风险，并为预防和治疗提供临床指导以改善孕产妇结局。
本研究共纳入525名孕妇。将产妇随机分为训练队列（n = 367）和测试队列（n = 158）。使用受试者操作特征（ROC）曲线下面积、校准曲线和决策曲线分析评估我们模型的性能。PI组所有女性均进行血培养检测，若检测到细菌，则进行药敏试验。记录并分析药敏谱。
单因素分析显示12项指标差异有统计学意义（P < 0.05）。Logistic回归分析显示，产次、阴道检查次数、产后出血量、入院前一周使用抗生素、引产和留置导尿管等6个因素在PI组和对照组之间差异有统计学意义（P < 0.05）。训练集ROC曲线下面积为0.904（95%CI：0.871 - 0.936），测试集为0.890（95%CI：0.837 - 0.942）。列线图的校准曲线显示预测值与观察值之间具有良好的一致性。临床决策曲线分析表明列线图具有实际意义。PI组血培养阳性患者100例， 为主要病原菌，占89%。对美罗培南和亚胺培南的敏感性为100%，对哌拉西林他唑巴坦为97.75%，对头孢他啶为95.51%，对阿莫西林/克拉维酸（AMC）为93.26%。
将阴道检查次数控制在4次以内、产后出血控制在414ml以内并减少尿道导尿管留置时间，可显著降低PI发生风险。如果临床诊断或高度怀疑PI，建议使用对 敏感的抗生素，如哌拉西林他唑巴坦、头孢他啶和AMC。
