Basic And Clinical Study On Surgical-site Infection After Cesarean Section

Objective To investigate the morbidity and high risk factors of surgical-site infection after cesarean section and to discuss predicted probability of infection when high risk factors exist in parturient. To study the sources of bacterium and try to find etiological factors that causes surgical-site infection. The effectiveness of antibiotic during pre-operative period was also observed .We try to find the best application methods of preventing infection that adapted to modern biological-psychological-social environment medical serve pattern. Methods1 We retrospectively reviewed all cesarean section cases in Guangdong province from June 1999 to June 2003. A retrospective case-control study of all parturient following surgical-site infection was conducted. Logistic regression analysis was applied to comprehend multiple-high risk factors of surgical-site infection.2 Three hospitals, including grade1A, grade2A and grade3A hospital, were selected. Monitoring markers of operation room were investigated. Plate sedimentation method was applied to monitor microorganisms in air and 5 points were monitored. Spread swab method was used to monitor instruments and tools in operation room.Over-qualitative quantitative determination method was used to monitor medical nursing staff' hands .3 Cesarean section cases were collected in Nanfang hospital from February to April 2004, cases with apparent preoperative infection were excluded. The test group 1 includes 9 parturient cases with premature rupture of membranes, the test group 2 includes 9 parturient cases with dilatation of cervix. The control group includes 16 parturient cases without premature rupture of membranes or dilatation of cervix. The tissue fluid of uterine cavity , placenta and fetal membranes were collected during operative process. The tissue fluid was cultured and the organisms were detected by multiplex PCR in laboratory room.4 80 parturient of practicing cesarean section from June 1999 to March 2004 were selected in NanFang hospital, YueBei hospital et al. The group was given prophylactic antibiotic. The control group involve randomly selected 85 parturient was given antibiotic during postoperative term. The outcome indices included average hospitalization days, fluid replacement days after operative, charges of antibiotic during housing facility and healing state of wound.Results1 96(0.7%) cases among 13798 parturient were found with surgical-site infection. Main symptom was distended and spring pain. The emergence time of symptom of major cases(78.13%) was 4-7 days after operation.The etiology of 60.42% cases was detected and the positive ratewas 56.89%. The pathogen was mostly found as E.coli , enterococcus was the next, Corynebacterium was the least. Therapeutic alliance included antibiotic, nutrient support , local therapy and the local therapy was the main measure. The local therapy included drainage procedure, infrared radiation and ultra-short wave therapy. The antibiotic therapy was confusion and albumin intromission was main method in support therapy.2 The high risk factors of surgical-site infection following cesarean section were obesity, deficit antibiotic prophylaxis, low -ferrohemoglobin content, existing infection before hospitalization, frequently vaginal examination, premature rupture of membranes, operative length time.3 The predicted probability of parturient with frequently vaginal examination is 75.2% that results from the results of judging classification analysis. We add i n following agents step by step, the predicted probability is difference. Deficit antibiotic prophylaxis is 75. 2%, low -ferrohemoglobin content is 82. 4%, operative length time is 81. 7%, obesity is 86. 3%, premature rupture of membranes is 83. 7%, existing infection before hospitalization is 84. 9%.4 In the air monitoring marker of operation rooms, 23.33% monitoring point of grade 1A is un-normal, grade 2A hold 13.33%, the part of grade 3A hospital also has dead angle existing microo...