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目的分析孕产妇院内感染的临床特点,探讨发生院内感染的危险因素,为制定防治措施提供参考。方法 2008年1月-2013年6月在临安市锦城街道社区卫生服务中心住院的孕产妇3 814例,按有无院内感染分为两组,观察组103例,对照组3 711例,对所有患者的临床资料进行回顾性分析。结果 3 814例孕产妇中发生院内感染者103例,发生率为2.7%。观察组住院时间显著长于对照组(8.2±2.6)d vs.(5.1±0.5)d(P<0.01)。院内感染患者中以呼吸系统感染发生率最高(1.1%),占全部感染人数的40.8%;其中67例行病原菌检测,共检测出病原菌51株,检出率为76.12%。革兰阳性菌检出率(40.3%)略高于革兰阴性菌(34.3%),检出率最高的致病菌为金黄色葡萄球菌(20.9%)。组间比较发现,观察组高危孕产妇(55.3%vs.42.7%)、助产或剖宫产(75.7%vs.51.9%)、侵入性诊疗(51.5%vs.11.0%)及住院时间≥5 d(89.3%vs.22.4%)患者比例均显著高于对照组(P<0.05)。多因素Logistic回归分析显示,高危孕产妇(OR=4.805,P<0.05)、助产或剖宫产(OR=3.587,P<0.05)、侵入性诊疗(OR=3.460,P<0.05)为孕产妇发生院内感染的危险因素。结论该院孕产妇院内感染现患率较低,病原菌以革兰阳性菌略多,高危孕产妇、助产或剖宫产、侵入性诊疗是孕产妇发生院内感染的高危因素。
Objective To analyze the clinical characteristics of nosocomial infection in pregnant women, to explore the risk factors of nosocomial infection and to provide reference for making prevention and treatment measures. Methods From January 2008 to June 2013, 3 814 pregnant women were hospitalized in the Community Health Service Center of Jincheng Street, Lin’an City. According to the presence or absence of nosocomial infection, they were divided into two groups: 103 cases in the observation group and 3 711 cases in the control group. The clinical data of all patients were retrospectively analyzed. Results A total of 103 cases of nosocomial infections occurred in 3 814 pregnant women, the incidence was 2.7%. The length of stay in the observation group was significantly longer than that in the control group (8.2 ± 2.6) d vs. (5.1 ± 0.5) d (P <0.01). Among the nosocomial infections, the highest incidence was respiratory infection (1.1%), accounting for 40.8% of the total number of infections. Among them, 67 were detected by pathogenic bacteria, and 51 strains were detected, the detection rate was 76.12%. The positive rate of Gram-positive bacteria (40.3%) was slightly higher than that of Gram-negative bacteria (34.3%). The highest detection rate was Staphylococcus aureus (20.9%). The comparison between the two groups found that the high-risk pregnant women (55.3% vs.42.7%), midwifery or cesarean section (75.7% vs.51.9%), invasive treatment (51.5% vs.11.0%) and hospital stay≥5 d (89.3% vs.22.4%) patients were significantly higher than the control group (P <0.05). Multivariate Logistic regression analysis showed that high-risk pregnant women (OR = 4.805, P <0.05), midwifery or cesarean section (OR = 3.587, P <0.05) Maternal nosocomial infection risk factors. Conclusion The prevalence rate of nosocomial infection in pregnant women in this hospital is low. The number of pathogens is slightly higher in Gram-positive bacteria. High-risk pregnant women, midwifery or cesarean delivery are the most important risk factors for nosocomial infection in pregnant women.