Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

Mitt, Piret; Lang, Katrin; Peri, Aira; Maimets, Matti

doi:10.1086/502566

Cited by 87 publications

(79 citation statements)

References 23 publications

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“…8 Obstetric care services should be strengthened in rural areas. 59% of the patients were nulliparous which is similar to that of study in Mitt et al 9 Tran et al reported that the risk factor of surgical site infection was shown to be reduced by 39% and 60% when women had one or more children respectively. 10 Majority of the cases were unbooked which correlates with Amenu D et al study.…”

Section: Discussionsupporting

confidence: 83%

Surgical site infections post cesarean section

Devi¹,

Durga²

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Surgical site infections are among the most common hospital acquired infections. They make upto 14-16% of inpatient infections. Objective of present study was to evaluate the risk factors associated with surgical site infections and the bacteria causing wound infections in obstetric operations and the antibiotic sensitivity and resistance pattern of the pathogens isolated.Methods: 100 women with wound infection during hospital stay or within 30 days following surgery. Pus samples were collected from the wound site with help of sterile swabs under aseptic precautions and immediately transported to microbiology laboratory for culture and sensitivity.Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55% of the cases. Majority of the women are from rural areas (71%). 57% of the cases were unbooked. 90% of the SSI were seen in emergency surgeries. Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders 25%. The risk of post operative infection has been shown to be proportional to volume of blood loss during cesarean section and duration of surgery. Staphylococcus aureus to be predominant organism of wound infection of which 21% were MRSA followed by Klebsiella and E.coli. The gram negative isolates were 100% resistant to ampicillin followed by 22.5% to third generation cephalosporins and aminoglycosides.Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the development of strategies for reducing the incidence of SSI and for identifying high risk patients requiring intensive postoperative surveillance.

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Section: Discussionsupporting

confidence: 83%

Surgical site infections post cesarean section

Devi¹,

Durga²

2018

Int J Reprod Contracept Obstet Gynecol

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“…Sustaining and developing local microbiology capacities are significant priorities in order to document the emergence of antimicrobial resistance. An achievement of this surveillance was to show the national and international community that a small- Our surveillance also underlines that an effective post-discharge surveillance is essential for ensuring accurate estimates of post-caesarean SSSI rate [26,27] and is feasible in limited-resource settings. Had we not implemented particular procedures after discharge to assess the wound healing process of patients (telephone call, follow-up visits), half of the cases would have been missed.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia

Srun

Yin

Seng

et al. 2013

J Infect Dev Ctries

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Introduction: In Cambodia, we implemented a pilot surveillance of superficial surgical site infections (SSSI) following caesarean deliveries (CD) in a provincial hospital, to estimate their incidence, describe their clinical management, and determine their causative pathogens. Methodology: Between October 2010 and February 2011, all women admitted for CD were included in the surveillance. Their clinical condition was monitored for a post-operative period of 30 days, including two assessments performed by surgeons. Cases were clinically diagnosed by surgeons, with bacterial cultures performed. Results: Of the 222 patients admitted for CD, 176 (79.3%) were monitored for 30 days. Of these, 11 were diagnosed with a SSSI, giving an incidence rate of 6.25% (95% CI 3.2-10.9). Four of the cases (36.4%) were detected after hospital discharge. Length of hospitalization was significantly longer for the SSSI cases. All 222 patients were prescribed antibiotics. Ampicillin was administered intravenously to 98.6% of them, with subsequent oral amoxicillin given to 82.9%. Three of six pus samples collected were positive on culture: two with Staphylococcus aureus and one with Staphylococcus lugdunensis. One S.aureus was methicillin resistant (MRSA). The other was clindamycin and erythromycin resistant. Conclusion: Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective postdischarge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.

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“…1 The rates of SSI after cesarean section reported in the literature range from 3% to 15%, depending on the surveillance methods used to identify infections, the patient population, and the use of antibiotic prophylaxis. [2][3][4][5][6][7][8][9][10][11] The pooled mean rate of SSI after cesarean section for US hospitals participating in the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System is 3.15%. 12 Expanding our knowledge of the risk factors associated with SSI is essential to developing targeted prevention strategies to reduce the risk of SSI.…”

Section: Infect Control Hosp Epidemiol 2008; 29:477-484mentioning

confidence: 99%