Obstet & Gynecol：剖宫产前给予抗生素治疗可有效降低院内感染率

近日，来自华盛顿大学医学院的研究者的研究结果指出，在妇女剖宫产手术之前给予抗生素可以明显降低其感染的比率，研究者David表示，我们跟踪观察了8000个妇女长达8年时间，我们可以肯定在剖宫产术之前给予抗生素确实可以阻止感染的发生。相关研究成果刊登在了近日的国际杂志Obsterics & Gynecology上。

这项研究中，研究者在2003年一月至2010年12月之间，进行了剖腹产分娩跟踪以及外科部位伤口感染调查，2003年时，感染比率为每100个剖腹产病人中会有9-10人感染，此后，随着医院颁布相关的法规，这种感染率有所降低，直到2010年时，感染比例降低为每100个人感染2人，在8年的跟踪调查过程中，研究者跟踪的8668人中，有303人发生了感染。

研究者指出，卫生政策的相应改变也会明显降低感染的比率，尽管现在医院病人的数量相比之前有所增加。相关研究成果由疾控中心CDC提供支持。

编译自：Timing of Antibiotics Important in Reducing Infections After C-Section

doi:10.1097/AOG.0b013e31825f032a
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Long-term effect of infection prevention practices and case mix on cesarean surgical site infections.

Kittur ND, McMullen KM, Russo AJ, Ruhl L, Kay HH, Warren DK.

OBJECTIVE: : To estimate trends in patient characteristics and obstetric complications in an 8-year cohort of patients undergoing cesarean delivery and to use time series analysis to estimate the effect of infection prevention interventions and secular trends in patient characteristics on postcesarean delivery surgical site infections. METHODS: : A multivariable autoregressive integrated moving average model was used to perform time series analysis on a 96-month retrospective cohort of patients who underwent cesarean delivery (January 2003-December 2010) in a U.S. tertiary care hospital. RESULTS: : We identified 8,668 women who underwent cesarean delivery. Median age was 26 years (range 12-53 years), 3,093 (35.7%) of patients had body mass indexes (BMIs) of 35 or greater, 2,561 (29.5%) were of white race, and 303 (3.5%) had a surgical site infection. Over the study period, there was a significant increase in the proportion of patients who underwent cesarean delivery who had BMIs of 35 or higher, hypertension or mild preeclampsia, and severe preeclampsia or eclampsia. A nonseasonal autoregressive integrated moving average model with a linear trend and no autocorrelation was identified. In the multivariable autoregressive integrated moving average model of postcesarean surgical site infections, implementation of a policy to administer prophylactic antibiotics within 1 hour before incision, instead of at the time of cord clamp, led to a 48% reduction in cesarean delivery surgical site infections (Δ=-5.4 surgical site infections per 100 cesarean deliveries; P<.001). CONCLUSION: : A change in policy to administer prophylactic antibiotics before incision resulted in a significant reduction in postcesarean surgical site infections.