摘要
目的分析导致血流感染孕产妇母婴不良预后的危险因素。方法选择2021年1月1日至2024年1月31日同济大学附属妇产科医院·上海市第一妇婴保健院妇产科收治的血流感染孕产妇314例为研究对象(血流感染组),选择同时间段于本院产检且整个孕期未发生血流感染的孕产妇300例为对照组,收集两组孕产妇的临床资料进行回顾性分析。根据妊娠结局将314例血流感染孕产妇分为正常结局组(240例)和不良结局组(74例)。对正常结局组和不良结局组患者的一般资料、血流感染临床症状和指标、病原菌分离进行单因素分析,对差异有统计学意义的指标进一步行Logistic多因素二元回归分析,探讨影响血流感染孕产妇发生母婴不良结局的危险因素。结果血流感染组孕产妇妊娠不良结局发生率为23.57%(74/314),显著高于对照组(8.00%、24/300),差异具有统计学意义(χ^(2)=27.717、P<0.001)。不良结局组和正常结局组血流感染孕产妇年龄[(36.56±4.56)岁vs.(29.45±5.02)岁:t=10.877、P<0.001]、孕前体重指数(BMI)[(25.09±2.21)vs.(22.64±1.31):t=12.245、P<0.001]、最高体温分布(χ^(2)=30.250、P<0.001)、是否发生感染性休克(χ^(2)=40.968、P<0.001),WBC(χ^(2)=65.677、P<0.001)、CRP(χ^(2)=13.977、P<0.001)和PCT(χ^(2)=17.452、P<0.001)水平分布、原菌种类数(χ^(2)=29.216、P<0.001)差异均有统计学意义。而两组患者学历、居住地、工作情况、孕产史和本次妊娠胎数、感染发生时间、感染来源、感染病程和病原菌类型差异均无统计学意义(P均>0.05)。Logistic多因素二元回归分析结果显示,是否发生感染性休克(OR=3.695、95%CI:1.627~5.462、P=0.037)、感染原菌种类数(OR=18.746、95%CI:10.630~27.651、P=0.049)和PCT水平(OR=33.683、95%CI:21.533~40.029、P=0.011)均为导致血流感染孕产妇发生母婴不良结局的危险因素。结论发生感染性休克、PCT水平异常升高和混合病原菌感染均为评估血流感染孕产妇发生母婴不良结局的重要指标。
Objective To identify the risk factors that lead to maternal and infant adverse outcomes of bloodstream infection.Methods Total of 314 pregnant women with bloodstream infection were selected from the Department of Obstetrics,Obstetrics and Gynecology Hospital of Tongji University Shanghai First Maternity-Infant Hospital From January 1st 2021 to January 31st 2024 as the study subjects(bloodstream infection group),during the same period,300 pregnant women who had no bloodstream infection of the whole pregnancy period and had undergone prenatal examination were selected as control group,the clinical data of two groups of pregnant women were collected for retrospective analysis.According to the pregnancy outcome,314 pregnant women with bloodstream infection were divided into normal outcome group(240 cases)and adverse outcome group(74 cases).The general information,clinical symptoms and indicators of bloodstream infection and pathogen isolation of patients in normal outcome group and adverse outcome group were analyzed by univariate analysis.The indicators with statistically significant differences were further analyzed by Logistic multivariate binary regression analysis to explore the risk factors affecting maternal adverse outcomes of bloodstream infection.Results The incidence of adverse pregnancy outcomes of cases in bloodstream infection group was 23.57%(74/314),significantly higher than that of the control group(8.00%,24/300),with significant difference(2=27.717,P<0.001).Between pregnant women in normal outcome group and adverse outcome group,age[(36.56±4.56)years old vs.(29.45±5.02)years old:t=10.877,P<0.001],pre-pregnancy body mass index(BMI)[(25.09±2.21)vs.(22.64±1.31):t=12.245,P<0.001],the highest body temperature distribution(χ^(2)=30.250,P<0.001),occurrence of septic shock(χ^(2)=40.968,P<0.001),level distribution of WBC(χ^(2)=65.677,P<0.001),CRP(χ^(2)=13.977,P<0.001)and PCT(χ^(2)=17.452,P<0.001),and the number of original bacterial species(χ^(2)=29.216,P<0.001)were all with significant differences.There was no significant difference in educational background,residence,working conditions,pregnancy and childbirth history,number of fetuses in this pregnancy,time of infection,source of infection,course of infection and pathogen type between the two groups(all P>0.05).The results of multivariate Logistic regression analysis showed that the occurrence of septic shock(OR=3.695,95%CI:1.627-5.462,P=0.037),the number of infectious bacteria(OR=18.746,95%CI:10.630-27.651,P=0.049)and PCT level(OR=33.683,95%CI:21.533-40.029,P=0.011)were all risk factors for adverse maternal and infant outcomes in pregnant women with bloodstream infection.Conclusions Infectious shock,abnormal increase of PCT level and mixed pathogen infection are important indicators to evaluate maternal adverse outcomes ofbloodstream infection.
作者
李婷
崔萍
何海燕
Li Ting;Cui Ping;He Haiyan(Department of Obstetrics,Obstetrics and Gynecology Hospital of Tongji University Shanghai First Maternity and Infant Hospital,Shanghai 201204,China)
出处
《中华实验和临床感染病杂志(电子版)》
2025年第3期175-181,共7页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
上海市第五批技术规范化管理和推广项目(No.SHDC22024211)。
关键词
血流感染
孕产妇
不良结局
抗菌药物
病原体
Bloodstream infection
Pregnant women
Poor outcomes
Antibiotics
Pathogens
