Martens M G, Kolrud B L, Faro S, Maccato M, Hammill H
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
J Reprod Med. 1995 Mar;40(3):171-5.
Wound infections are a common surgical complication, often requiring a prolonged hospital stay and leading to increased costs. Over a one-year period, 2,431 patients were followed after cesarean delivery with prompt evaluation and culture of all suspicious wounds. Seventy subjects (2.8%) developed confirmed wound infection, and 42 (1.7%) developed noninfected open surgical wounds. Seven (0.3%) fascial dehiscences were diagnosed, requiring surgical repair. Forty of 63 (64%) infected wounds had positive bacterial cultures, with Staphylococcus epidermidis (29%), Enterococcus faecalis (17%), Staphylococcus aureus (17%), Escherichia coli (11%) and Proteus mirabilis (10%) the most frequent isolates. Only 7 of 42 (17%) noninfected wounds had positive cultures, with only S aureus, S epidermidis and Corynebacterium species isolated. Ninety-five percent of the noninfected wounds had blood or serous collections present. Rupture of membranes lasting longer than six hours, emergency cesarean delivery and morbid obesity were associated with a statistically increased likelihood of the development of infected wounds. Emergency cesarean delivery and morbid obesity, but not prolonged rupture of membranes, were associated with an increased likelihood of the development of noninfected wounds. Therefore, it appears that at least two mechanisms are responsible for the development of postcesarean open wounds: (1) increased amniotic fluid and wound colonization due to prolonged rupture of membranes, resulting in a wound infection containing one or more bacterial species derived from the cervicovaginal flora, and (2) increased exogenous bacterial contamination and flora consistent with skin species or breaks in sterile technique, often accompanying difficult or emergency surgery.
伤口感染是一种常见的手术并发症，常常需要延长住院时间并导致费用增加。在一年的时间里，对2431例剖宫产术后的患者进行了随访，对所有可疑伤口进行了及时评估和培养。70名受试者（2.8%）发生了确诊的伤口感染，42名（1.7%）出现了未感染的开放性手术伤口。诊断出7例（0.3%）筋膜裂开，需要进行手术修复。63例感染伤口中有40例（64%）细菌培养呈阳性，最常见的分离菌株为表皮葡萄球菌（29%）、粪肠球菌（17%）、金黄色葡萄球菌（17%）、大肠杆菌（11%）和奇异变形杆菌（10%）。42例未感染伤口中只有7例（17%）培养呈阳性，仅分离出金黄色葡萄球菌、表皮葡萄球菌和棒状杆菌属。95%的未感染伤口有血液或浆液性渗出物。胎膜破裂持续超过6小时、急诊剖宫产和病态肥胖与感染伤口发生的统计学可能性增加相关。急诊剖宫产和病态肥胖，但不是胎膜破裂时间延长，与未感染伤口发生的可能性增加相关。因此，似乎至少有两种机制导致剖宫产术后开放性伤口的发生：（1）由于胎膜破裂时间延长导致羊水增加和伤口定植，从而导致含有一种或多种源自宫颈阴道菌群的细菌种类的伤口感染，以及（2）外源性细菌污染增加和与皮肤菌种一致的菌群或无菌技术的破坏，常伴随困难或急诊手术。
