摘要目的:调查重症监护病房（ICU）孕产妇脓毒症流行病学资料，分析ICU孕产妇脓毒症常见病因和结局及多重耐药菌感染发生的危险因素。方法:采用回顾性队列研究方法，选择2008年1月至2022年9月北京大学第三医院、首都医科大学附属北京朝阳医院、首都医科大学附属北京友谊医院3家医院ICU收治的脓毒症孕产妇患者的临床资料，包括一般特征、感染期间序贯器官衰竭评分（SOFA）、感染时机、感染部位、感染前有创操作、微生物培养结果、感染期间血常规、体温、感染导致的临床结局。根据脓毒症发生时间将患者分为ICU前发生脓毒症组和ICU期间发生脓毒症组，分析两组发生脓毒症的病因。根据是否发生多重耐药将患者分为多重耐药组和非多重耐药组，分析两组的临床结局。采用多元Logistic回归方法分析脓毒症孕产妇发生多重耐药菌感染的危险因素。结果:共纳入160例脓毒症孕产妇患者，其中转入ICU前发生脓毒症104例，ICU期间发生脓毒症56例；多重耐药53例，非多重耐药107例。160例患者的中位年龄30.5（28.0，34.0）岁，中位体温38.8（38.2，39.5）℃，中位白细胞计数（WBC）17.2（13.2，21.3）×10 9/L，中位SOFA评分5.0（3.0，8.0）分，外院转诊130例（81.2%）；感染部位主要为宫腔64例（占40.0%）、肺部48例（占30.0%）、腹盆腔30例（占18.8%）、泌尿系统27例（占16.9%）；脓毒症导致子宫切除6例（3.8%）、死胎8例（5.0%）、新生儿死亡2例（1.3%）；感染导致的手术干预措施以剖宫产术为主（44例，占27.5%），其次为开腹探查（19例，11.9%）；中位ICU住院时间5.0（3.0，10.0）d，中位总住院时间14.0（10.0，20.8）d。宫腔感染是ICU期间发生脓毒症的首要原因，占50.0%（28/56），其中产后大出血占85.7%（24/28）。多重耐药组患者糖尿病比例〔28.3%（15/53）比14.0%（15/107）〕、宫腔操作〔41.5%（22/53）比23.4%（25/107）〕、宫腔感染〔50.9%（27/53）比34.6%（37/107）〕及菌血症〔18.9%（10/53）比2.8%（3/107）〕均显著高于非多重耐药组（均 P<0.05）。多元Logistic回归分析显示，糖尿病〔优势比（ OR）＝2.348，95%可信区间（95% CI）为1.006~5.480， P＝0.048〕和宫腔操作（ OR＝2.541，95% CI为1.137~5.678， P＝0.023）是脓毒症孕产妇发生多重耐药菌感染的独立危险因素。 结论:宫腔感染是ICU孕产妇发生脓毒症的常见原因，产后大出血是ICU内继发宫腔感染的常见病因。多重耐药菌可导致严重临床结局，糖尿病及宫腔操作是多重耐药菌感染的独立危险因素。

abstractsObjective:To investigate the epidemiological data of maternal sepsis in intensive care unit (ICU), analyze the common causes, outcomes of maternal sepsis, and the risk factors of multi-drug resistant (MDR) bacteria.Methods:A retrospective cohort study. Maternal sepsis cases admitted to ICUs of Peking University Third Hospital, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2008 to September 2022 were enrolled. The following data were recorded: demographic characteristics, sequential organ failure assessment (SOFA) during infection, infection time, infection sites, invasive intervention measures before infection, microbial culture results, blood routine test during infection, body temperature, and clinical outcomes caused by infection. According to the time of sepsis occurrence, the patients were divided into pre-ICU sepsis group and ICU sepsis group, and the causes of sepsis in the two groups were analyzed. According to whether MDR occurred, the patients were divided into MDR group and non-MDR group, and clinical outcomes were analyzed. Multivariate Logistic regression was used to analyze the risk factors of MDR bacteria infection in obstetrics with sepsis.Results:160 patients were enrolled, among which 104 cases of sepsis happened before ICU and 56 cases of sepsis happened during ICU, 53 cases were with MDR bacteria and 107 cases were without MDR bacteria. The median age of the patients was 30.5 (28.0, 34.0) years old, the median temperature was 38.8 (38.2, 39.5) ℃, and the median white blood cell count (WBC) was 17.2 (13.2, 21.3)×10 9/L, the median SOFA score was 5.0 (3.0, 8.0), and 130 cases (81.2%) were referred from other hospitals. The main infection sites were uterine cavity in 64 cases (40.0%), lung in 48 cases (30.0%), abdominal and pelvic cavity in 30 cases (18.8%), urinary system in 27 cases (16.9%). Sepsis led to hysterectomy in 6 cases (3.8%), stillbirth in 8 cases (5.0%), and neonatal death in 2 cases (1.3%). The main surgical intervention measures were cesarean section (44 cases, accounting for 27.5%), followed by exploratory laparotomy (19 cases, 11.9%). The median length of ICU stay was 5.0 (3.0, 10.0) days, and the median hospital length was 14.0 (10.0, 20.8) days. Intrauterine infection was the primary cause of sepsis happened during ICU, accounting for 50.0% (28/56), of which postpartum hemorrhage accounted for 85.7% (24/28). The proportion of diabetes [28.3% (15/53) vs. 14.0% (15/107)], intrauterine operation [41.5% (22/53) vs. 23.4% (25/107)], intrauterine infection [50.9% (27/53) vs. 34.6% (37/107)] and bacteremia [18.9% (10/53) vs. 2.8% (3/107)] in the MDR group were significantly higher than those in the non-MDR group (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes [odds ratio ( OR) = 2.348, 95% confidence interval (95% CI) was 1.006-5.480, P = 0.048] and intrauterine operation ( OR = 2.541, 95% CI was 1.137-5.678, P = 0.023) were independent risk factors for MDR bacterial infection in obstetrics with sepsis. Conclusions:Intrauterine infection is the common cause of maternal sepsis in ICU, and postpartum hemorrhage is the common cause of secondary intrauterine infection in ICU. MDR bacteria can lead to serious clinical outcomes. Diabetes and intrauterine operation are independent risk factors for MDR bacteria' infection.