Khaleda Akter, Megan Folks, Temilola-Azeezat Bakare, Mary Fornek, Briana Episcopia, Marie Abdallah, Ngozi Nwankpa, John Quale
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引用次数: 0
Abstract
Objective: To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population.
Design: Retrospective case-control study and multivariable regression analyses.
Setting: Multicenter urban hospital system.
Participants: All women undergoing C-sections during 2023.
Methods: To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs.
Results: Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY.
Conclusions: For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.
目的：在服务不足的城市人群中确定剖腹产后手术部位感染（ssi）的危险因素。设计：回顾性病例对照研究和多变量回归分析。环境：多中心城市医院体系。参与者：2023年期间所有剖腹产的女性。方法：为了确定ssi的危险因素，将ssi患者与倾向匹配的对照组（控制以下变量：年龄、体重指数、糖尿病、美国麻醉学会（ASA）评分、伤口分类和手术时间）进行比较。此外，我们还进行了多变量logistic回归分析，以确定ssi的独立风险。结果：在4,642例剖腹产中，发现73例ssi；90%为出院后检出。与倾向匹配组相比，SSI队列中更多的患者接受庆大霉素联合克林霉素（相对于头孢唑林为主的方案）；庆大霉素的剂量一直低于推荐水平。此外，与对照组相比，SSI组中近期移民到美国的患者明显更多（20.5% vs 4.1%, P = 0.004）。多变量回归分析揭示了ssi的3个独立危险因素：ASA评分、在没有妇产科住院医师计划的医院进行手术、居住在纽约布朗克斯区。结论：对于生活在低社会经济地位地区的妇女，大多数剖腹产后的ssi是在出院后发现的。新移民和生活在高度贫困地区的妇女尤其面临更高的风险。解决健康的更广泛的社会决定因素，特别是在服务不足的地区，对于减少性行为伤害和改善总体孕产妇健康结果至关重要。
期刊介绍：
Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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