Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania

Abstract

BackgroundSurgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs.MethodsThis was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11.ResultsThe overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6–9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%.ConclusionSSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple factors. Strategies to control these factors are urgently needed to control SSIs post CS at Bugando Medical Centre and other centres in developing countries.

Surgical Site Infection Among Gynaecological and Obstetric Abdominal Surgeries.

“…In present study, a significant association was 144 observed between higher ASA grade and prevalence of SSI (Grade I, II and III: 4.3%, 23.1% & 20%; p<0.05). Various studies have shown that ASA score greater than 2 is a risk factor for development of SSIs [28][29][30][31]. Morgan et al [28] in their study observed that ASA score of more than two was associated with increase in risk of SSI by 1.52 times.…”

Prevalence and Microbial Etiology of Surgical Site Infections Following Major Abdominal Gynecologic Surgeries in a Tertiary Care Center

“…Among 103 cases of discharge sent for culture and sensitivity only 54 cases (52%) yielded positive culture report .Studies conducted by Filbert J Mpogoro,1 Stephen E Mshana, also yielded only 48% culture positive cases [6] Of the 54 cases, 23(42.6%) cases were Klebsiella Species, 20 (37%) were Staphylococcus aureus ,9( 16.7%) cases were MRSA and 2 (3.7% ) cases were E coli. The most common organism causing SSI in abdominal surgeries is usualyE.coli .…”

“…This may be due to less number of cases. Studies done by Leong G1, Wilson J, Charlett also prove that duration of surgery is directly proportional to SSI [5] SSI was diagnosed if any one of the criteria was present -localized swelling/edema at wound / redness, or discharge from the wound or positive organisms in the culture report.…”

Evaluation of Antibiotics Use and Bacteria Profile of Caesarean Section at Regional General Hospital, Pasuruan

“…Isolat lainnya termasuk 5 (22,7%) Klebsiella spp, 3 (13,6%) Escherichia coli, 2 (9,1%) Acinetobacter spp, 2 (9,1%) Pseudomonas spp, 1 (4,5%) Proteus spp, 1, (4,5%) Enterobacter spp, 1 (4,5%) Micrococcus spp, dan 1 (4,5%) koagulase negatif Staphylococcus spp. 6 Penggunaan antibiotik profilaksis pada intraoperasi secara tepat dapat mengurangi ILO. Antibiotik profilaksis diberikan kepada pasien dengan tujuan untuk mengurangi jumlah bakteri yang ada dan membantu pertahanan alami dari host sehingga infeksi dapat dicegah.…”