Surgical site infection and its association with rupture of membrane following cesarean section in Africa: a systematic review and meta-analysis of published studies

Abstract

Introduction Surgical site infection occurs within 30 days after a surgical procedure and involves the skin, subcutaneous tissue, and soft tissue. Surgical site infection following cesarean section is a common postoperative complication and is associated with maternal morbidity and mortality in resource-limited settings. Even though the proportion of surgical site infection and some risk factors were reported by kinds of literature, varying results were stated across studies. There is also limited knowledge on the association between postpartum surgical site infection and the rupture of membrane. Hence, this systematic review and meta-analysis was designed to estimate the pooled proportion of surgical site infection and its association with rupture of membrane following cesarean section in Africa. Methods Studies published from January 01, 2000 to January 30, 2020 were searched from MEDLINE via PubMed, Scopus, Medscape, Web-science and CINAHL databases to search relevant published articles. We also performed a manual search of reference lists of key articles to retrieve additional relevant articles. Initially, 559 records were identified and 15 studies included in the analysis. The statistical analysis was performed using STATA 11. Heterogeneity between-study was explored by forest plot and inconsistency index (I2). The publication bias was checked by a funnel plot and Egger’s test. Pooled estimates of proportion and odds ratio were calculated by a random-effects model with a 95% confidence interval (CI). Results The overall pooled proportion of surgical site infection following cesarean section was 10.21% (I2 = 86.8, p < 0.000; 95% CI = 8.36, 12.06). The odds of developing surgical site infection among women who had the rupture of membrane before delivery were nearly 6 times higher than those who had not a rupture of the membrane (AOR = 5.65, 95% CI: 3.95–8.07). Conclusions The proportion of surgical site infections following the cesarean section is relatively high. Women who had rupture of the membrane before delivery were more likely to develop surgical site infections following the cesarean section. Due attention should be given to the provision of prophylactic antibiotics that can reduce surgical site infection after cesarean delivery.

Prevalence of post‐caesarean section surgical site infections in Rwanda: A systematic review and meta‐analysis

“…Comparing the results of this meta‐analysis with other meta‐analyses, the results of this meta‐analysis are comparable with the results of the meta‐analysis of the global incidence of surgical site infections following caesarean section which reported a global prevalence of 5.63% using 180 studies conducted in 58 different countries 7 . In contrast, the result of the current meta‐analysis is different from other meta‐analyses including the study done on the African level reporting post‐caesarean SSI prevalence of 10.21%, 27 as well as 15.6% prevalence as reported in the review that pooled the prevalence of post‐caesarean SSIs in Sub‐Saharan Africa, 28 but both lack any study conducted in Rwanda.…”

The risk factors and nursing countermeasures of sepsis after cesarean section: a retrospective analysis

“…We did not use catheters for all patients in this present study, only the patients have difficulty in urination for more than four hours got postoperative urinary tubes. Postoperative puerpera's vulva lochia and blood oozing from traumatic tissues increase the probability of contamination of the long-term indwelling catheter, which may enter the blood through urethral mucosal damage [40,41]. Therefore, the indwelling catheter must be strictly followed and evaluated for removal.…”

Post cesarean section surgical site infection and associated factors among women who delivered in public hospitals in Harar city, Eastern Ethiopia: A hospital-based analytic cross-sectional study

“…Consistent with reports from different settings ROM before CS is positively and significantly associated with SSI. A meta-analysis on the association between membrane rapture and SSI reported a six-fold increase in post-CS SSI [ 35 ]. A case control study in Sierra Leone also reported a 50% increase in SSI among women with premature ROM [ 36 ].…”