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

Abstract

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.

A case–control study of risk factors for surgical site infection after cesarean delivery in eastern Burkina Faso

“…A study in Nigeria [5] found that in 25% of cases of surgical site infection, the operative indication was fetopelvic disproportion compared with 15.3% in control cases. In Cambodia, patients with fetopelvic disproportion were 3.5 times more likely to present a surgical site infection after cesarean delivery [14].…”

Factors associated with caesarean sections in Phnom Penh, Cambodia

“…19 In Cambodia, estimates range from 14% to 30%. 4,19,20 Of 21 countries surveyed in 2010-2011, Cambodia had the largest increase in c-section rate (+ 16.8% per year between 2007-2008 and 2010-2011). 19 Comparisons of successive Cambodian Demographic and Health Surveys (CDHS) also suggest a sharp increase from 0.8% to 6.3% in the country, and from 4.6% to 14.4% in Phnom Penh between 2000 and 2014.…”

“…2,3 They lead to more hospital-acquired site infections, and delays in breastfeeding. 4,5 C-section can also compromise future pregnancies, and have long term negative effects for the newborns, such as obesity, asthma, type-1 diabetes, and lead to unexplained stillbirths in the second pregnancy. 2,[6][7][8][9][10][11][12] These risks explain why c-section on demand is considered, "an expensive and dangerous luxury".…”

Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section

“…3,4 In many institutions, the antibiotic administration is performed after the umbilical cord has been clamped, justified by the neonatal impact of antimicrobial use. 4,5 Although antimicrobial prophylaxis reduces the risk of endometritis and incisional SSI when administered correctly, much has been discussed about its real impact due to the small number of studies and their limitations. 4,6,7 The rates of SSI after CS reported in the literature ranges from 3% to 15%, depending on the surveillance methods used to identify infections, the patient population, and the use of antibiotic prophylaxis.…”