Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt

Abstract

Background The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. Methods The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. Results During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15–16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69–10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45–5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14–4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04–3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78–3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26–2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11–2.39; p = 0.021). Conclusions The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.

Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia

“…This was also consistent with different studies conducted in Ethiopia hospitals [ 16 , 18 , 36 – 38 ], and a systematic review and meta-analysis in Ethiopia also support the findings [ 39 ]. This finding is also similar with other studies conducted in different countries such as Eritrea [ 23 ], Egypt [ 10 ], Uganda [ 28 ] and Nigeria [ 24 ]. This relationship between duration of labor and SSI may be due to increased exposure time for infection and the fact that as duration of labor increase, number of vaginal examinations also increased, and this increases the likelihood of acquiring infections.…”

“…The prevalence of current study was higher than the result reported from different studies, which indicated the magnitude of SSI 2.8% in Egypt 2.87% [ 10 ], 2.1% in Kuwait [ 29 ], and 4.25% in Gujarat, 4.5% in in China [ 30 ], 2.4% in Peru [ 31 ], and 1.44% in Brazilian [ 32 ]. The possible reasons for the discrepancy could be due to difference in socio-economic status and health policy.…”

“…The prevalence of current study was higher than the result reported from different studies, which indicated the magnitude of SSI 2.8% in Egypt 2.87% [10], 2.1% in Kuwait [29], and…”

“…In Sub-Saharan African (SSA) countries, SSI is the most frequent complication in surgery and up to 20% of women who give birth by caesarian delivery developed SSI [ 4 ]. The magnitude of SSI in SSA ranges from 2.87% in Egypt [ 10 ] to 10.9% in Tanzania [ 11 ].…”

Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region

“…This was expected because the hospital under study is a reference hospital for high-risk pregnancies. It is also known that premature rupture to the membrane contributes to the colonization of the microbiota from the lower genital tract in the amniotic fluid, leading to wound and peritoneal cavity contamination [25].…”