LOWER SEGMENT CESARIAN SECTION SURGICAL SITE INFECTION: RISK FACTOR AND MICROBIAL ETIOLOGY

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and foetus. Surgical site infections (SSI) are the most common reason about 20% to be unplanned admitted after discharging of the patient to their home. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labour >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. Purulent discharge was obtained from the surgical incision site 48 hours postoperatively with sterile disposable swabs. Blood sample for blood culture was collected when the possibility of septicemia or bacteremia as suggested by the presence of fever, shock, or other signs and symptoms of sepsis associated with the surgical wound. The bacterial isolates obtained were identified as per standard identification procedures in time microbiology laboratory. Antibiotic susceptibility of the organisms done as per protocol. RESULTS: A total of 646 patients were included in the study of which 94 (14.55%) were diagnosed as SSI. mean age of patients who underwent LSCS was 24± 4.57 years. Of the 646 patients in 18 - 20 years 125 (19.3%),21-25 years 304 (47.1%), 26-30 years 189 (29.3%) and in > 30 years age group 28 (4.3%) cases were observed, of the total 94 SSI cases 11 (8.8%) were in the age group if 18 - 20 years, 39 (12.8%) were in the age group of 21-25 years, 32 (16.9%) were in 26-30 years age group and 12 (42.9%) were in the > 30 years age group. Acinetobacter spies was the commonest isolate 29(30.9%) followed by staphylococcus aureus 22 (23.4%), Escherichia coli 21 (22.3%) and Klebsiellapneumoniae. premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be statistically significant. It was interpreted that PROM > 24 hrs is likely to increase the chances of infection. As the duration of hospital stay increases by 1 day, the chances of infection increase. CONCLUSION: Identification, management and proper assessment of risk factors are necessary to in reduction of SSI rates. Premature rupture of membrane (PROM), antibiotics given earlier than 2 hours, BMI >25 and increased duration of stay in the hospital were associated with increased SSI rate.

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TO ASSESS THE SPECTRUM OF LESIONS IN LYMPH NODES IN HEAD AND NECK REGION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i2.638 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Dr. Bipin Gandhi

Keyword(s):

Risk Factors ◽

Neck Region ◽

Surgical Site Infections ◽

Signs And Symptoms ◽

Purulent Discharge ◽

Age Group ◽

Premature Rupture ◽

Related Factors ◽

Duration Of Stay ◽

Lower Segment Cesarean Section

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LOWER SEGMENT CESARIAN SECTION SURGICAL SITE INFECTION: RISK FACTOR AND MICROBIAL ETIOLOGY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i7.356 ◽

2019 ◽

Vol 3 (7) ◽

Author(s):

Dr. Manish Bhatt ◽

Dr. Ela Bhatt

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Surgical Site Infection ◽

Clinical Signs ◽

Surgical Site Infections ◽

Klebsiella Pneumonia ◽

Site Infection ◽

Lower Segment ◽

Related Factors ◽

Lower Segment Cesarean Section

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and fetus. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labor >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. Diagnosis of surgical site infection requires evidence of clinical signs and symptoms of infection which may be further supported by microbiological evidence. MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors. RESULTS: Among 646 cesarean sections, surgical site infection was observed in 27(4.1%) cases while he remaining cases had no surgical site infection. Mean age of cases with surgical site infection was observed to be 14.8 years with sd of 3.9 years where as it was 22.1 years in cases with no surgical site infections and sd of 3.2 years. Average number of stay in hospital is found to be 14.1 and 7.3 days respectively in cases with and without surgical site infections. Antibiotics were given on 17.3 days on average in cases with SSI whereas patients without surgical site infections were on antibiotics for 3.1 days on average. Out of total 27 surgical site infection E-coli was isolated in 11(40.8%) cases followed by 7(25.9%) isolations of staphylococcus aureus. Klebsiella pneumonia and pseudomonas aeruginosa were isolated in 3(11.1%) cases each. Acitenobacter was found in only 1(3.7%) case. 2(7.4%) isolates were not identified in our study. CONCLUSION: To reduce the SSI rates post LSCS, proper assessment of risk factors and their modification is required. Frequent antibiotic susceptibility testing for resistance is required.

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Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

European Journal of Inflammation ◽

10.1177/2058739220960547 ◽

2020 ◽

Vol 18 ◽

pp. 205873922096054

Author(s):

Faiz Ullah Khan ◽

Yu Fang ◽

Zakir Khan ◽

Farman Ullah Khan ◽

Zafar Iqbal Malik ◽

...

Keyword(s):

Risk Factors ◽

Transurethral Resection ◽

Surgical Site Infections ◽

Exploratory Laparotomy ◽

Cross Sectional Study ◽

Surgical Patients ◽

Related Factors ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

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Health and welfare profile of Australian baby boomers who live in rented accommodation – implications for the future

Ageing and Society ◽

10.1017/s0144686x17001088 ◽

2017 ◽

Vol 39 (4) ◽

pp. 685-702 ◽

Cited By ~ 1

Author(s):

ANNE W. TAYLOR ◽

RHIANNON PILKINGTON ◽

ELEONORA DAL GRANDE ◽

CONSTANCE KOURBELIS ◽

HELEN BARRY

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Baby Boomers ◽

Chronic Conditions ◽

South Australia ◽

Related Factors ◽

Housing Status ◽

Logistic Regression Models ◽

Multiple Covariates ◽

Private And Public

ABSTRACTBaby boomers who rent are often overlooked as an important sub-group. We aimed to assess the chronic conditions, risk factors, socio-economic factors and other health-related factors associated with renting in private or public housing. Data from telephone interviews conducted each month in South Australia between 2010 and 2015 were combined. Prevalence estimates were assessed for each risk factor and chronic condition by housing status. The association between housing status and variables of interest were analysed using logistic regression models adjusting for multiple covariates (age, gender, income, smoking, physical activity, area and year of data collection). Overall, 17.4 per cent of the 16,687 baby boomers interviewed were renting, either privately or using government-subsided housing. The health profile of renters (both private and public) was poorer overall, with renters more likely to have all of the chronic conditions and ten risk factors assessed. For public renters the relationships were maintained even after controlling for socio-economic and risk factor variables for all chronic diseases except osteoporosis. This research has provided empirical evidence of the considerable differences in health, socio-economic indicators and risk factors between baby boomers who rent and those who own, or are buying, their own homes.

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Risk factors for surgical site infections after caesarean section at Yaounde, Cameroon

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214309 ◽

2021 ◽

Vol 10 (11) ◽

pp. 4048

Author(s):

Pierre M. Tebeu ◽

Aurelien Kamdem ◽

Jean P. Ngou-Mve-Ngou ◽

Esther Meka ◽

Jesse S. S. Antaon ◽

...

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infections ◽

Biomedical Sciences ◽

Midline Incision ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Cross Sectional ◽

Factors Associated ◽

Chi Squared

Background: Surgical site infection is the invasion by microorganisms of the tissue layers affected by the surgical procedure. Maternal morbidity from infections has been shown to be higher after caesarean section compared to the vaginal delivery. Objective of the research was to analyze the risk factors associated with surgical site infections after caesarean section.Methods: This was a cross sectional (affected/non affected) study approved by the institutional committee for ethics and research of the faculty of medicine and biomedical sciences. A total of 310 medical files were assessed, 62 files from patients with surgical site infections and 248 files from patients without any complications. The data was collected using a pretested questionnaire and analyzed using the statistical package for the social sciences (SPSS) software version 22.0. The Chi squared and the Fisher exact tests were used to assess homogeneity between the 2 groups. Odd ratio 95% confidence interval was used to assess the association between the variables.Results: The proportion of surgical site infections during the study was 1.81%. Factors associated with surgical site infections were premature rupture of membranes (OR: 2.065; 95% CI 1.051-4.05; p=0.035); the vertical midline incision (OR=5.26; 95% CI; 1.41-19.57; p=0.013) and a operation by a resident physician doctor (OR=1.98; 95% CI 1.09-3.59; p=0.02).Conclusions: A factors associated with surgical site infections after caesarean section are a premature rupture of membranes, vertical midline incision and the qualification of the practitioner.

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The role of young children in a community-wide outbreak of hepatitis A

Epidemiology and Infection ◽

10.1017/s0950268897007462 ◽

1997 ◽

Vol 118 (3) ◽

pp. 243-252 ◽

Cited By ~ 68

Author(s):

P. F. SMITH ◽

J. C. GRABAU ◽

A. WERZBERGER ◽

R. A. GUNN ◽

H. R. ROLKA ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Relative Risk ◽

Jewish Community ◽

Attack Rate ◽

Odds Ratio ◽

Hepatitis A ◽

Age Group ◽

Recurrent Hepatitis

An Hasidic Jewish community has experienced recurrent hepatitis A outbreaks since 1980. To assess risk factors for illness during a 1985–6 outbreak, the authors reviewed case records and randomly selected 93 households for an interview and serologic survey. In the outbreak, 117 cases of hepatitis A were identified, with the highest attack rate (4·2%) among 3–5 year olds. Among the survey households, the presence of 3–5 year olds was the only risk factor that increased a household's risk of hepatitis A (indeterminant relative risk, P=0·02). Furthermore, case households from the outbreak were more likely to have 3–5 year olds than were control households from the survey (odds ratio=16·4, P<0·001). Children 3–5 years old were more likely to have hepatitis A and may have been the most frequent transmitters of hepatitis A in this community. Hepatitis A vaccination of 3–5 year olds can protect this age group and might prevent future outbreaks in this community.

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Risk factors for wound infection after lower segment cesarean section

Qatar Medical Journal ◽

10.5339/qmj.2012.2.9 ◽

2012 ◽

Vol 2012 (2) ◽

pp. 9 ◽

Cited By ~ 4

Author(s):

Fathia E. Al Jama

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Wound Infection ◽

Lower Segment ◽

Lower Segment Cesarean Section

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Sex difference in types and distribution of risk factors in ischemic and hemorrhagic stroke

International Journal of Stroke ◽

10.1177/1747493017724626 ◽

2017 ◽

Vol 13 (1) ◽

pp. 83-86 ◽

Cited By ~ 5

Author(s):

Alijan A Ahangar ◽

Payam Saadat ◽

Behzad Heidari ◽

Seyedeh T Taheri ◽

Shayan Alijanpour

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiovascular Disease ◽

Risk Factor ◽

Ischemic Stroke ◽

Sex Difference ◽

Cause Of Death ◽

Associated Factors ◽

Hemorrhagic Stroke ◽

Age Group

Background Stroke is the second leading cause of death worldwide and is associated with several risk factors with variable risk factor distribution by population. We report the types and frequency of the associated factors of stroke in north Iran. Methods Consecutive patients with stroke were recruited from 2014 to 2015. The two groups of ischemic and hemorrhagic stroke were compared with respect to age, sex, the prevalence, and distribution of the risk factors. Results Among 230 patients (84.3% ischemic stroke) with mean age of 61.2 years, hypertension (73%), diabetes mellitus (53%), cardiovascular disease (51%), and dyslipidemia (47%) were the most frequent risk factors. Hypertension was significantly more prevalent in males compared with females (88% vs. 60%, OR = 4.91, 95% CI: 2.48–9.71). Hypertension, smoking, and opioid consumption were associated with hemorrhagic stroke. Dyslipidemia was significantly higher in ischemic stroke (OR = 2.65, 95% CI: 1.21–5.8). Overall, 84.3% of stroke occurred in patients aged >50 years (92.8% of women vs. 74.5% of the men, OR = 4.43, 95% CI: 1.93–10.16, p = 0.001). Conclusion Stroke was more prevalent in females; hypertension was more prevalent in males. In the age group less than 50 years old, stroke is more prevalent in men.

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Fertility Recovery Following Allogeneic Bone Marrow Transplantation in Aplastic Anemia; A Study of 157 Patients

Blood ◽

10.1182/blood.v126.23.4783.4783 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4783-4783

Author(s):

Feras Alfraih ◽

Shad Ahmed ◽

Dennis Dong Hwan Kim ◽

Walid Rasheed ◽

Ghuzayel Aldawsari ◽

...

Keyword(s):

Risk Factors ◽

Bone Marrow ◽

Risk Factor ◽

Aplastic Anemia ◽

Median Duration ◽

Research Funding ◽

Independent Risk Factor ◽

Age Group ◽

Significant Difference ◽

Fertility Recovery

Abstract Introduction : Infertility is a major late effect of hematopoietic stem cell transplants (HSCT). In aplastic anemia (AA) patients, although the fertility recovery rate is relatively higher than other diseases but the exact incidence and risk factors are not very well studied. In this study, we attempted to evaluate incidence and the impact of patientÕs characteristics and transplantation procedures on fertility recovery following allogeneic HSCT for adolescent and adults patients with AA. Methods : A total of 157 patients who were at least 14 years old with AA receiving HSCT between year 1987 and 2014 at our center were reviewed. Patients who survived at least 2 years following HSCT and either married or in relationship were included in the analysis and evaluated for fertility following HSCT. 87 patients were eligible for the study. Questionnaire survey and long-term charts were used for data collection. With a response rate and or available information of 63% patients, 55 patients were identified and stratified into fertility recovery (FR+) versus non-fertility recovery (FR-) group. Fertility recovery was defined by a pregnancy of the patient or his partner. Results: Median age for all patients is 23 years (range, 14 -50), 44% (n=24) between 14-20 years old, 51% (n=28) between age 20-40 years and 5% (n=3) > 40 years. 51% (n=28) were females. Matched related donor was used for majority of patients 96% (n=53). GVHD prophylaxis was CSA/MTX for 93% (n=51,). Conditioning regimen was Cyclophosphamide/Flu in 25 (45%), Cyclophosphamide /ATG in 18 patients (35%) and others in 12 patients (20%). Bone marrow was the source of stem cells for 52 patients (94%). A median follow-up of 8 years for survivors (range, 0.3 -23) showed 45 patients (82%) had FR+ while 10 patients (18%) were FR-. Median duration of fertility recovery (from delivery to BMT) was 6 years (range, 0.8-19) with significant difference based on age groups, 4 years for patients 20-40 years (n=29, 53%) versus 8 years for those < 20 years (n=24, 44%), (p=0.002), (Figure 1). None of the patients >40 years old (n=2, 4%) had fertility recovery. Comparison based on gender showed no significant difference. Males had a median duration of fertility recovery of 5.9 years, (range 0.6-14.9) versus 6.2 years, (range, 0.8-15.2) (p=0.31) females. The overall median number of pregnancies was 2 (range, 1-6). For males, it was 2 (range, 1-6) while 1.5 (range, 1-5) for females (p=0.26). Deliveries occurred in natural ways in (95%) while C-section for (5%). All deliveries were without fetal abnormalities. Univariate analysis of risk factors for fertility recovery showed age group (p=0.03) and chronic GVHD (p=0.05) are important factors. Neither gender of patients or type of preparative regimens used for HSCT (Cyclo/ATG vs Cyclo/Flu) was a risk factor. In multivariate analysis, age group was the only confirmed an independent risk factor for fertility recovery (p=0.02) [HR= 2.02, CI=1.012-3.64). Conclusion: The present study suggested that the incidence of fertility recovery following HSCT for patients with aplastic anemia is high with no significant differences between males and females. Patients between the ages of 20-40 years at the time of HSCT have significantly shorter recovery period. Age was the only independent risk factor for fertility recovery while there was no impact of whether ATG or Fludarabine was used in addition to Cyclophosphamide as preparative regimen. Figure 1. Figure 1. Disclosures Kim: Bristol-Myers Squibb: Consultancy, Research Funding; Novartis Pharmaceuticals: Consultancy, Research Funding.

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182 Cases of Premature Rupture of Membranes and Treatment Strategy Analysis

Advanced Emergency Medicine ◽

10.18686/aem.v4i4.8 ◽

2015 ◽

Vol 4 (4) ◽

pp. 23

Author(s):

Wenxian Dai

Keyword(s):

Risk Factors ◽

Survival Rate ◽

Cesarean Section ◽

Treatment Strategy ◽

Treatment Strategies ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Strategy Analysis ◽

Related Factors ◽

Preterm Premature Rupture

Objective: Related factors and treatment strategies of premature rupture of membranes (PROM) were discussed. Method: Retrospective analysis of 182 cases of preterm premature rupture of membranes (PPROM) from Yanshan County Hospital from January 2010 to October 2015. Results: From the 182 cases [123 vaginal delivery and 59 cesarean section (C-section)], there were 79.12% PROM cases were detected in the presence of risk factors. Neonatal mortality and complications were significantly higher at 28−33 + 6 weeks of pregnancy than those at 34−36 + 6 weeks, 28−33 + 6 weeks, and 34−36 + 6 weeks. Conclusion: In order to improve the survival rate of newborns, the related factors leading to PPROM should be treated.

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