Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: a prospective cohort study

Abstract

Background: Despite the availability of prophylactic antibiotics prior to skin incisions, surgical site infection (SSI) following cesarean section (CS) remains an unresolved health issue. As a result, this study aimed to assess the incidence and predictors of SSI after a CS. Methods: The authors conducted a prospective cohort study in eastern Ethiopia. The women were serially enrolled until the desired sample size was reached. A structured questionnaire was used to collect data. Women were followed at the hospital during their weekly visits. Culture-based microbiological methods were used to identify causal agents. A binary logistic regression model was used to identify the predictors of SSI after CS. Results: Among serially enrolled women, 336 were followed for 30 days. The incidence of SSI was 7.74% (95% CI: 7.68–7.80). Rupture of the membrane before operation [adjusted odds ratio (AOR)=3.75, 95% CI: 1.85–16.6], labor duration greater than 24 h (AOR=4.04, 95% CI: 1.52–10.79), and postoperative hemoglobin less than 11 g/dl (AOR=3.42, 95% CI: 1.32–8.87) were all significantly associated with SSI. The most common isolated pathogen was Staphylococcus aureus , followed by Escherichia coli . Conclusions: Nearly one-tenth of the women developed SSIs. Factors such as rupture of the membrane before the operation, absence of antenatal care, labor duration greater than 24 h, a midline skin incision, and postoperative hemoglobin less than 11 g/dl were the predictors of SSI. To reduce the incidence of SSI, policymakers should consider the importance of high-quality antenatal care, shorten the duration of labor, and maintain women’s hemodynamics in future SSI prevention bundles.

The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis

“…Six studies ( 35 , 37 , 38 , 41 , 49 , 52 , 54 ) were included to determine the relationship between emergency cesarean sections and surgical site infections. Except for the one study ( 35 ) that found a significant association, the remaining five studies ( 37 , 38 , 41 , 49 , 52 , 54 ) did not find a significant association.…”

“…Six studies ( 35 , 37 , 38 , 41 , 49 , 52 , 54 ) were included to determine the relationship between emergency cesarean sections and surgical site infections. Except for the one study ( 35 ) that found a significant association, the remaining five studies ( 37 , 38 , 41 , 49 , 52 , 54 ) did not find a significant association. This meta-analysis revealed that no relationship existed between emergency cesarean section and surgical site infection (AOR = 1.09.95% CI: 0.95–1.24), with no heterogeneity (I 2 = 0, p = 0.721; Figure 8 ).…”

“…The relationship between membrane rupture and surgical site infection was examined in five studies ( 34 , 37 , 41 , 46 , 52 , 53 ), while the relationship with membrane rupture greater than or equal to 12 h was examined in five studies ( 38 , 44 , 45 , 47 , 55 ). One study for mothers with membrane rupture ( 37 ) and the other study for those with membrane rupture greater than or equal to 12 h ( 45 ) did not show a significant association, while the remaining study had a significant association.…”

“…The relationship between membrane rupture and surgical site infection was examined in five studies ( 34 , 37 , 41 , 46 , 52 , 53 ), while the relationship with membrane rupture greater than or equal to 12 h was examined in five studies ( 38 , 44 , 45 , 47 , 55 ). One study for mothers with membrane rupture ( 37 ) and the other study for those with membrane rupture greater than or equal to 12 h ( 45 ) did not show a significant association, while the remaining study had a significant association. Mothers with membrane ruptures (AOR = 2.04, 95% CI: 1.24–2.85), as well as those ruptured of membrane greater or equal to 12 h (AOR = 3.93, 95%CI: 1.93–5.92), were more likely to develop surgical site infection than mothers with intact membrane and ruptured membrane less than 12 h, respectively ( Figure 9 ).…”

“…Three studies ( 41 , 45 , 49 ) were used to examine the relationship between longitudinal incision and surgical site infection, while four studies ( 37 , 40 , 46 , 50 ) were used to examine the relationship between midline incision and an infection at the surgical site. In the longitudinal incision, only one study ( 41 ) had a significant association, whereas in the midline incision, only one study ( 40 ) did not have a significant association.…”