Incidence and risk factors for maternal surgical site infection after cesarean section.

Abstract

Objective: To ascertain the frequency and risk factors for post-operative surgical site infection (SSI) in cesarean section. Study Design: Cross-sectional study. Setting: Departments of Gynecology & Obstetrics and Anesthesiology, Secondary Care Hospital. Period: January to December 2017. Material & Methods: After the approval of hospital ethical committee, 337 parturient who underwent cesarean section were included in our study. Outcomes were: frequency and risk factors for post-cesarean wound infection. Data was analyzed by SPSS version 20. Qualitative data presented as frequency and percentage. Chi-square (Fishers test) used to analyze significance. P-value ≤ 0.05 taken as significant. Results: A total of 337 patients were included in our final analysis. The frequency of wound infection was 15 (4.4%). The mean age was 27.5 years ± 5.8 in our study population. There was no difference in age (p=0.781), parity (p=0.898), antenatal visits (p=0.319), referral from doctor (p=0.205), anemia (p=0.731), nature of surgery (elective or emergency LSCS) p=0.548, severity of anemia (p=0.962), blood grouping Rh-factor (p=0.531), chorioamnionitis (p=0.707), labor (p=0.955), premature rupture of membrane (p=0.427) and antepartum hemorrhage (p=0.769). 11 (3.3%) of the patients with SSI were treated conservatively while 4 (1.2%) required debridement and secondary suturing. None of our patients required referral to tertiary care hospital for treatment of SSI. Conclusion: The incidence of SSI after cesarean section was less in our study and we didn’t find maternal age, gestational age, previous cesareans delivery, antenatal visits, PROM, labor before LSCS, anemia to be associated with risk of SSI.

Incidence, Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study

“…Reported in Felegehiwot referral hospitals (7.8%), 30 Debretabor General Hospital (8%) 14 Nekemte referral hospitals (8.9%), 5 and Zewditu Memorial Hospital (8.4%). 18 This incidence is also higher than study conducted in other African countries such as 5.34% in Egypt, 6 7.3% in sub-Saharan Africa, 31 Asian countries, 5.8% in Pakistan, 17 and 1.7% in China 7 and others developed countries, the United States of America (5%), 21 and Ankara (6.2%). 22 Moreover, in agreement study conducted in Ayder referral hospital (11.7%) 19 and Sierra Leone (11%).…”

“…Clinical practice recommendations for SSI prevention include, but not limited to, preoperative bathing, surgical site preparation, surgical hand preparation, appropriate use of antibiotics to reduce the risk of infection, and applied infection prevention technique. 16 , 17 …”

“…15 Clinical practice recommendations for SSI prevention include, but not limited to, preoperative bathing, surgical site preparation, surgical hand preparation, appropriate use of antibiotics to reduce the risk of infection, and applied infection prevention technique. 16,17 Several studies on surgical site infections after cesarean section have been conducted in Ethiopia. However, most studies used a cross-sectional design to determine factors associated with surgical site infection after cesarean section.…”

Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India

“…A single dose of prophylactic antibiotic, injection cefazolin was given and if not available, injection cefotaxime was given 30 minutes to one hour before skin incision for both elective and emergency caesarean sections. The incidence of SSI is low compared to most Indian studies, which have reported a burden ranging from 3.12% to as high as 24.2% over the last decade [7,[14][15][16][19][20][21]. Most of these studies did not follow the WHO guidelines on pre-operative antibiotic use, and some even used multiple antibiotics in multiple doses before or after surgery [15,[19][20][21].…”

“…The incidence of SSI is low compared to most Indian studies, which have reported a burden ranging from 3.12% to as high as 24.2% over the last decade [7,[14][15][16][19][20][21]. Most of these studies did not follow the WHO guidelines on pre-operative antibiotic use, and some even used multiple antibiotics in multiple doses before or after surgery [15,[19][20][21]. Therefore, we recommend adherence to the guidelines unless there is evidence-based justification to deviate from them.…”