Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

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Incision and Prediction of Risk Factors Related to Surgical Site Infection Following Cesarean Section in Chinese Women

10.20944/preprints202109.0436.v1 ◽

2021 ◽

Author(s):

Qiuxiang Huang

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Pregnant Women ◽

Chinese Women ◽

Severe Infection ◽

Control Group ◽

Site Infection ◽

Gynecology And Obstetrics ◽

Group Data

Cesarean Section (CS) is one of the most frequently executed surgical procedures in gynecology and obstetrics. After a cesarean section, surgical site infection (SSI) increases hospital stay, lengthens maternal morbidity, and upsurges treatment costs. The current study determines the prevalence and risk factors for surgical site infection following cesarean section in China. A retrospective study was conducted on 23 cases of pregnant women who underwent cesarean section and incision severe infection and detection from March 2017 to January 2020 at Wuhan Maternal and Child Healthcare Hospital in China as the study group, and 20 cases of uninfected cesarean section during the same period were selected as the control group. Data were compared with the controls based on study variables and the presence of SSI. The mean age was 31±2.6. High fever and blood loss were observed in serous SSI-infected patients. The incidence rate of severe surgical site infection was 0.15 %. SSI was observed to be expected in pregnant women who had premature rupture of membrane before surgery (p < 0.001), who underwent postoperative antibiotic therapy (p < 0.001), and the patients who had gestational diabetes mellitus (p <0.001) and hematoma (p < 0.001) during surgery. Hence, following a cesarean section, surgical site infection is common. This research discovered several modifiable risk factors. SSI is associated with multifactorial rather than a single one. The development and strict implementation of a procedure by all health care practitioners can successfully reduce and prevent infection rates following cesarean section.

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Surgical Site Infection after Caesarean Section: Epidemiology, Microbiology, Management and Prevention in a Tertiary Health Facility in Niger Delta Region, Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i530849 ◽

2021 ◽

pp. 82-95

Author(s):

Eugene M. Ikeanyi ◽

Isaac J. Abasi ◽

Ninabai N. Ofuruma

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infection ◽

Niger Delta ◽

Financial Burden ◽

Surgical Techniques ◽

Significant Risk ◽

Control Group ◽

Site Infection ◽

Estimated Blood Loss

Background: Surgical site infection despite marked advances in surgical techniques and preventive measures continues to contribute substantially to hospital morbidity, financial burden and mortality. Aims: This study was designed to measure surgical site infection rate following caesarean section, investigate the risk factors and the pattern of the offending microbes. The paucity of SSI data from authors’ center influenced the desire to contribute data to cesarean section-related SSI. Study Design: A case control study. Place and Duration of Study: Niger Delta University Teaching Hospital Bayelsa State Nigeria between May 2018 and March 2020. Methodology: Consenting cases of caesarean procedure-related surgical site infection were recruited as study group and the next non-infected caesarean patients as the control group. Descriptive statistics was done with EPI Info and Instat software. Relative risk (RR) determined association of variables and SSI with p-value <.05. Results: Twenty six (9.4%) of the 276 caesarean section cases had surgical site infection. Unbooked status (RR 2.4, p=0.003), BMI≥30mgm-2(RR 2.2, p=0.02), surgery duration > 60 minutes (RR 5.3, p=0.03), interrupted stitch (RR 3.0, P<0.001), prolonged rupture of fetal membranes (p=0.008), chorioamnionitis (RR2.68, p=0.002), estimated blood loss>1000ml (p=0.02) were significant risk factors for SSI. SSIs had longer postoperative hospital stay median (IQR) 14.5(10-21) vs.6.0 (5-7), P<.001. Obstructed labor (42.3%) was responsible for most of SSIs after C-section. Wound discharge (37%), fever (23%) and wound dehiscence 17% were the main clinical features of SSI. The most isolated microorganisms were staphylococcus aureus (22.7%), klebsiella species and Escherichia coli 18.2% each and they were predominantly susceptible to quinolones and gentamicin and resistant to beta-lactam antibiotics. Conclusions: Surgical site infection after C-section is still common in Nigeria. The factors were multifactorial and largely modifiable.

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Incidence and risk factors for surgical site infection post-gynecological operations in a tertiary hospital in Egypt: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20220056 ◽

2022 ◽

Author(s):

Khaled Goma ◽

Saad El Gelany ◽

Ahmed Fawzy Galal

Keyword(s):

Risk Factors ◽

Risk Stratification ◽

Surgical Site Infection ◽

Tertiary Hospital ◽

Control Group ◽

Site Infection ◽

Duration Of Surgery ◽

Prolonged Duration ◽

Significant Burden ◽

Matched Case

Background: Surgical site infection (SSI) is the most common complication of surgical procedures in gynecology and it poses a significant burden for both patients and healthcare systems. Our objective was determining the incidence and risk factors for SSI post-gynecological operations during the period of five years.Methods: A matched case-control study at Minia maternity university, Egypt where A total of 18772 cases had undergone different gynecological procedures. The 876 cases were complicated with SSI (SSI cases group) and 2 matched controls per case were chosen from the rest of the cases and served as the control group (n=1752 cases).Results: The overall incidence of SSI post-gynecological operations was 4.67% and post-hysterectomy was 7.57%. SSI group had a significantly higher number of cases with diabetes, obesity, high parity (>4), increased blood loss and those had prolonged duration of surgery compared to the control group (all p<0.01).Conclusions: The identified risk factors are crucial for risk stratification of SSI and prioritizing interventions to improve the outcome. These results could give a picture for SSI post-gynecological operations in our country and identifying these risk factors is crucial for risk stratification of SSI and prioritizing interventions to improve the outcome.

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Risk Factors for Surgical Site Infection in Spinal Surgery and Interventions: A Retrospective Study

10.21203/rs.3.rs-96344/v1 ◽

2020 ◽

Author(s):

Rikiya Saruwatari ◽

Kei Yamada ◽

Kimiaki Sato ◽

Kimiaki Yokosuka ◽

Tatsuhiro Yoshida ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retrospective Study ◽

Surgical Site Infection ◽

Spinal Surgery ◽

Medical Staff ◽

Significant Risk ◽

Related Factor ◽

Site Infection ◽

Infection Surveillance

Abstract Background: Surgical site infection following spinal surgery causes prolonged delay in recovery after surgery, increases cost, and sometimes leads to additional surgical procedures. We investigated risk factors for the occurrence of surgical site infection events in terms of patient-related, surgery-related, and postoperative factors.Methods: This retrospective study included 1000 patients who underwent spinal surgery in our hospital between April 2016 and March 2019. Before September 2015, we observed multiple occurrences of spinal surgical site infections caused by methicillin-resistant Staphylococcus aureus, and we have since been culturing swabs taken from inside and outside the wound before postoperative wound closure as a form of surgical site infection surveillance.Results: The patient-related factors of dementia, length of preoperative hospital stay (≥14 days), diagnosis at the time of surgery (traumatic injury or deformity), surgery-related factor of multilevel surgery (≥9 intervertebral levels), and postoperative factor of time to ambulation (≥7 days) were statistically significant risk factors for spinal surgical site infection. A retrospective study of 392 patients who underwent spinal surgery between June 2009 and August 2011, before surgical site infection surveillance was implemented, showed that the incidence of surgical site infection was 4.59%, although in this study, it had dropped to 2.0%.Conclusion: The introduction of surgical site infection surveillance thus helps reduce the incidence of surgical site infection through measures taken by medical staff to prevent them and to improve associated problems. One risk factor identified in this study that is amenable to intervention is the time to ambulation. As delayed ambulation is a risk factor for postoperative surgical site infection, how medical staff can intervene in postoperative ambulation to further reduce the incidence of surgical site infection is a topic for future research.

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Incidence and Risk Factors of Recipient Surgical Site Infection in Oral and Maxillofacial Reconstruction with Vascularized Fibular Bone Grafts

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020742 ◽

2020 ◽

pp. 231

Author(s):

Pichai Vittayakittipong ◽

Sarocha Makmanee

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Significant Risk ◽

Bone Grafts ◽

Class Ii ◽

P Value ◽

Site Infection ◽

Physical Status ◽

Recipient Site ◽

Maxillofacial Reconstruction

Objective: To determine the incidence and risk factors of recipient surgical site infection (RSSI) after oral and maxillofacial reconstruction with vascularized fibular bone grafts (VFBG).Material and Methods: This retrospective study was performed in patients who underwent oral and maxillofacial reconstructive surgery, with VFBG, at the Dental Hospital, Faculty of Dentistry, Prince of Songkla University. Demographic, preoperative, intraoperative and postoperative data were recorded. Any infection at the recipient site occurring within 30 days post-operatively, by criteria from the Center of Disease Control, was defined as RSSI. Statistical analysis was performed by chi-square test, Student's t-test and Pearson’s correlation coefficient with statistical significance was set at 0.05.Results: There were twenty-one patients who met the eligibility criteria. The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was 47.6% (10/21 patients), and the success rate of VFBG was 95.2%. American Society of Anesthetics (ASA) physical status class II and oral contamination were significant risk factors for RSSI (p-value=0.004 and p-value=0.031, respectively). Length of hospital stay was significantly higher in the RSSI group (p-value<0.001).Conclusion: The incidence of RSSI after oral and maxillofacial reconstruction with VFBG was high, and ASA physical status class II and oral contamination were significant risk factors for RSSI.

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Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01972-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jinghong Meng ◽

Yanbin Zhu ◽

Yansen Li ◽

Tao Sun ◽

Fengqi Zhang ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Retrospective Study ◽

Surgical Site Infection ◽

Elective Surgery ◽

Site Infection ◽

Foot And Ankle ◽

Coagulase Negative Staphylococci ◽

Methicillin Resistant ◽

Associated Risk Factors

Abstract Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

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Risk factors of surgical site infection post cesarean section

BMC Proceedings ◽

10.1186/1753-6561-5-s6-p189 ◽

2011 ◽

Vol 5 (S6) ◽

Cited By ~ 1

Author(s):

MA Alishaq ◽

JA AlAjmi ◽

B Al-Ali ◽

F Saleh ◽

M El-Sheik ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Site Infection

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A study to assess the risk factors of surgical site infection among mother underwent cesarean section

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3137 ◽

2020 ◽

Vol 11 (4) ◽

pp. 5234-5237

Author(s):

Parimala L ◽

Prathiba P

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Emergency Surgery ◽

Assessment Scale ◽

Infection Prophylaxis ◽

Site Infection ◽

Previous Surgery ◽

Site Assessment

Surgical site infection (SSI) is the second most normal irresistible inconvenience after urinary tract disease following cesarean section (CS). Surgical site infection after a cesarean area is related with expanded maternal horribleness, delayed emergency clinic remain and expanded clinical expenses. The hazard for creating SSI has noteworthily diminished over the three decades, fundamentally inferable from progress in cleanliness condition anti-infection prophylaxis, sterile methodology and other practice. Despite this decrease, the occurrence of surgical site infection is expected in the continuous rise in the incidence of cesarean delivery. A quantitative approach with descriptive study design was chosen to assess the risk factor of surgical site infection among mothers who underwent cesarean section at Saveetha Medical College Hospital. Sixty mothers who fulfil inclusive criteria were selected by purposive sampling technique. Sociodemographic variables were collected by semi-structured questionnaire, and the risk factors were assessed by surgical site assessment scale. The result of the study shows that 22(36.6%) of the mothers were obese, 34 (56.6%) were anaemia, 22 (36.6%) had hypertension, 7 (11.6%) had diabetes mellitus,37 (61.6%) were prolonged hospitalized, 9(15%) of study subject had previous surgery and 18 (30%) of study subject had emergency surgery. The surgical site assessment scale reveals that 31(51.6%) comes under the no-risk category,29(48.3 %) comes under the risk among preoperative mothers, and 22(36.6%) comes under no risk, 38 (63.3 %) comes under risk among post-operative mothers who underwent cesarean section. Thus the factors such as anaemia, hypertension, diabetes mellitus, prolonged hospital stay, previous surgery, and emergency surgery increase the risk for surgical site infection among mothers who underwent cesarean section.

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PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA PROFILAKSIS PADA SEKSIO SESAR SESUAI ALUR KLINIS RSUP DR SARDJITO DENGAN ANTIBIOTIKA DOSIS MULTIPEL TERHADAP KEJADIAN INFEKSI LUKA OPERASI

Jurnal Kesehatan Reproduksi ◽

10.22146/jkr.35444 ◽

2016 ◽

Vol 3 (2) ◽

pp. 75

Author(s):

Ardian Rahmansyah ◽

Mohammad Hakimi ◽

Rukmono Siswishanto

Keyword(s):

Length Of Stay ◽

Cesarean Section ◽

Surgical Site Infection ◽

Clinical Pathway ◽

Intervention Group ◽

Group Versus ◽

Control Group ◽

Site Infection ◽

Short Term

Background: Clinical pathway recommend the use of short-term prophylaxis antibiotics for cesarean section. Long-term antibiotics or multiple doses was found in clinical practice. There are differences in the mode of administration and the number of doses administered at sardjito hospital.Objective: To determine the effectiveness of short-term antibiotic prophylaxis in cesarean section appropriate to clinical pathway in the prevention of surgical site infection (ssi), the incidence of fever, dysuria events, length of stay.Method: The study used randomized clinical trial. The study subjects who underwent cesarean section and meet the inclusion and exclusion criteria in the period July 2013 to January 2014 divided into an intervention group (n = 52) who received ampicillin 2 gram pre and post-cesarean section, and a control group (n = 54) who received ampicillin 2 gram pre cesarean section and 1 gram every 8 hours for 6 times. Observed on days 3 and 10 post-cesarean section. The primary outcomes assessed were the incidence of surgical wound infection based on the criteria of surgical site infection from Centers for Disease Controland Prevention. Secondary outcomes assessed were the incidence of fever, dysuria events, length of stay. Homogeneity analysis were conducted on subject. Outcome analysis performed bivariate with t test and chi squared test.Results and Discussion : A total of 106 subjects can be analyzed. SSI events in the intervention group at day 3 was 3.8% (n = 52) and control group was 1.84% (n = 54) with p>0.05 RR 2.077 (95% CI 0.194 to 22.219). SSI on day 10 of 7.7% (n = 52) in the intervention group versus 9.3% (n = 54) in controls with p<0.05 RR 0.831 (CI 95%, 0.236 to 2.924). Fever events on day 3 by 5.8% in the intervention group versus 3.7% incontrols with p>0.05 RR 1.558 (95% CI 0.271 to 8.948) and on day 10 was 3.8% versus 3.7 % with p>0.05 RR 1.038 (95% CI 0.152 to 7.102). Dysuria not found on day 3 and but on 10 found 5.8% in the intervention group versus 11.1% with p>0.05 RR 0.519 (IK95% 0.137 to 1.968). Length of stay after cesarean section for 3.21 ± 0.412 days in the intervention group and 3.26 ± 0.442 days in the control group with p>0.05 (95% CI -0.213 - 0.117).Conclusion: There is no significant difference in the incidence of surgical wound infections, the incidence of fever, dysuria, length of stay between short-term prophylaxis antibiotics ampicillin appropriate to clinical pathway and long-term or multiple doses prophylaxis antibiotics. Short term antibiotics prophylaxis are more efficiently with the same effectiveness in preventing outcomes research.Keywords: prophylaxis antibiotics, ampicillin, short term regimen, long term regimen, cesarean section, surgical site infection.

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Incidence of Surgical Site Infection among Post C Section Women Presented in Surgical Emergency of tertiary care hospital

10.53350/pjmhs211581836 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1836-1837

Author(s):

S Aliza Z Bokhari ◽

M. Irfan Fazal ◽

Maha Naseem ◽

M. Adnan Mumtaz ◽

S. Mahum Z Bokhari ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

Surgical Emergency ◽

Key Factor ◽

Questionnaire Form ◽

Aseptic Conditions

Aim: To rule out incidence and risk factors that are associated with infection at site of surgery after cesarean section. Method: A type of retrospective study was conducted on 100 women who underwent cesarean delivery procedures within a period of 8 month from September 2020 to April 2021 and presented in surgical emergency at Mayo Hospital Lahore. The socioeconomic, demographic and clinical parameters of patients were collected by a questionnaire form. A program known as SPSS version 20 was used for analysis of data that is collected in study. Result: After analyzing the data following factors are identified that causes surgical site infection: Higher BMI (more than 30kg/m2), loss of blood during cesarean section(more than 500mL), poor hygienic care after cesarean section, poor socioeconomic status leads to malnutrition of patient and that leads to poor wound healing and surgical site infection. Lack of education is also a key factor in SSIs. Cesarean done in emergency under improper aseptic conditions also promote SSIs. All these factors are associated with incidence of SSI. Conclusion: SSIS are conventional among women presented in surgical emergency of Mayo Hospital Lahore within 30 days of cesarean section. Management of risk factors causing SSIs in women after cesarean section may decrease the incidence of such infections. Keywords: Cesarean section, risk factors, infection at surgery site.

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