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

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. 

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khaled Gomaa ◽  
Ahmed R. Abdelraheim ◽  
Saad El Gelany ◽  
Eissa M. Khalifa ◽  
Ayman M. Yousef ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Control Group ◽  
Site Infection ◽  
Incidence Risk

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).

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

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.

scholarly journals Risk factors for deep surgical site infection following thoracolumbar spinal surgery

2020 ◽  
Vol 32 (2) ◽  
pp. 292-301 ◽  
Author(s):  
Hansen Deng ◽  
Andrew K. Chan ◽  
Simon G. Ammanuel ◽  
Alvin Y. Chan ◽  
Taemin Oh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Thoracolumbar Spine ◽  
Hospital Length Of Stay ◽  
Site Infection ◽  
Asa Classification ◽  
Estimated Blood Loss ◽  
History Of ◽  
The Mean

OBJECTIVESurgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.METHODSAll patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.RESULTSIn total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p < 0.001), were more likely to have an ASA classification > II (48.0% vs 36.0%, p < 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p < 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.CONCLUSIONSThis institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.

scholarly journals Assessment of risk factors for surgical site infection following caesarean section

2019 ◽  
Vol 8 (11) ◽  
pp. 4518
Author(s):  
Aditi Sangwan ◽  
Vani Malhotra
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Emergency Caesarean ◽  
Group I ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Wound Discharge ◽  
Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

Risk factors for surgical site infection following caesarean section in England

2013 ◽  
Vol 120 (4) ◽  
pp. 509-510 ◽  
Author(s):  
C Wloch ◽  
J Wilson ◽  
T Lamagni ◽  
P Harrington ◽  
A Charlett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Site Infection

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

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&plusmn;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 &lt; 0.001), who underwent postoperative antibiotic therapy (p &lt; 0.001), and the patients who had gestational diabetes mellitus (p &lt;0.001) and hematoma (p &lt; 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.

scholarly journals Predictive factors of surgical site infection after hysterectomy for endometrial carcinoma: a retrospective analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lijuan Shi ◽  
Qiao Gu ◽  
Fenghua Zhang ◽  
Daoyun Li ◽  
Wenfeng Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Surgical Site Infection ◽  
Endometrial Carcinoma ◽  
Blood Sugar ◽  
Stage Iv ◽  
Figo Stage ◽  
Site Infection ◽  
Estimated Blood Loss ◽  
Postoperative Serum

Abstract Background Surgical site infection (SSI) is a common postoperative complication. We aimed to analyze the potential risk factors of SSI in patients with endometrial carcinoma. Methods Patients with endometrial carcinoma who underwent surgery treatment in our hospital from Sept 1, 2018 to August 31, 2020 were included. We retrospectively compared the characteristics of SSI and no SSI patients, and logistic regression analyses were performed to identify the risk factors of SSI in patients with endometrial carcinoma. Results A total of 318 postoperative patients with endometrial carcinoma were included. The incidence of SSI in patients with endometrial carcinoma was 14.47 %. There were significant differences on the FIGO stage, type of surgery, durations of drainage, postoperative serum albumin and postoperative blood sugar (all p < 0.05), and no significant differences on the age, BMI, hypertension, diabetes, hyperlipidemia, estimated blood loss, length of hospital stay were found (all p > 0.05). FIGO stage IV (HR3.405, 95 %CI 2.132–5.625), open surgery (HR2.692, 95 %CI 1.178–3.454), durations of drainage ≥ 7 d (HR2.414,95 %CI 1.125–2.392), postoperative serum albumin < 30 g/L (HR1.912,95 %CI 1.263–2.903), postoperative blood sugar ≥ 10 mmol/L (HR1.774,95 %CI 1.102–2.534) were the independent risk factors of SSI in patients with endometrial carcinoma (all p <  0.05). Conclusions Measures including reasonable control of serum albumin and blood glucose levels, minimally invasive surgery as much as possible, timely assessment of drainage and early removal of the tube may be beneficial to reduce the postoperative SSI in in patients with endometrial carcinoma.

scholarly journals Incidence, risk factors and Microorganisms for post caesarean Surgical Site Infection In A Tertiary Care Centre in Bangladesh

2021 ◽  
Vol 28 (2) ◽  
pp. 136-141
Author(s):  
Shahfinaz Mehzabin ◽  
Mohmmad Mahbub Elahi ◽  
Debashish Bar ◽  
Banalata Sinha ◽  
Tahmina Akter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Medical College ◽  
Related Risk ◽  
Microbiological Methods ◽  
Duration Of Surgery ◽  
History Of

Background: Surgical site infection (SSI) is a common complication following caesarean section (C-section) and mainly responsible for increased maternal morbidity and higher treatment costs. This study will determine the incidence and risk factors of surgical site infections following caesarean section in Dhaka Medical College Hospital (DMCH). Materials and Methods: This is a retrospective observational study which was conducted among patients having post caesarean surgical site infections attending post-natal outdoor clinic of DMCH from January, 2019 to December, 2019. Data were collected in structured questionnaire. Culturebased microbiological methods were used to identify causal agents in postoperative wounds. Results: Overall SSI rate following caesarian section was 4.44%.Patient related risk factors were inadequate antenatal check-up, emergency procedures, malnutrition (22.44%), anaemia (21.46%) associated comorbidity (59.46%), history of rupture membrane >12 hours (40.98%) and had history of prolonged labour pain >12 hours (16.10%).Surgery related risk factors were repeated per vaginal examinations by untrained birth attendant (21.95%) & duration of surgery>1 hour (62.93%). The most common organisms responsible for SSI were Staphylococcus aureus 44(21.46%) and Escherichia coli 31(15.12%). The most sensitive antibiotics were aminoglycosides, cephalosporin & cloxacillin. Conclusion: Most of the risk factors for surgical site infection following caesarean section identified in this study can be modified through intervention. However the microorganisms detected from our patient showed a high degree of resistance for commonly prescribed antimicrobials in our set-up. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 136-141

scholarly journals Risk Factors Associated With 55 1 In Elective Gastrointestinal Surgery: A Prospective Study In A Specialized Surgical Centre

2019 ◽  
Vol 16 (2) ◽  
pp. 71-75
Author(s):  
Aminul Islam Joarder ◽  
Mohammad Salahuddin Faruque ◽  
M Nur E Elahi ◽  
Ishrat Jahan ◽  
Omar Siddiqui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Smoking Habit ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Operation Time ◽  
Drain Tube ◽  
Site Infection ◽  
A Prospective Study ◽  
Surgery Department

Background: Understanding SSI and providing feedback to the surgical team has been shown to reduce the incidence of surgical site infection and the cost incurred due to it. Objective: To assess the risk factors of surgical site infection (SSI) in elective gastrointestinal surgery. Methods: prospective data were collected on 1122 surgical patients admitted in the surgery department in BSMMU from January 201 0 to July 201 2. All preoperative risk factors were evaluated .Patients operated were followed in the post operative period and if any wound infection noted, swab from the site of infection was sent for culture and sensitivity and antibiotics were given accordingly. Results: The incidence of SSI was 1 83(1 6.31 %).Out of this 1 83 cases 65.6% had BMI <25. Anaemia was present in 45.90% cases, bronchopulomnary disease was present in 1 1 .5% cases and DM & jaundice was present in 8.1 9% and 28.9% cases accordingly. 69(37.7%) cases were habitual smoker.SSI rate progressively increased with rate of contamination and maximum infection occurred in lower GIT surgery which was 144(1 7.84%). SSI developed more, in 1 02 (55.74 %) cases when duration of peration was more th ;1 1 1;1.2 hours. In 73.8% cases of SSI drain tube was used. Statistically significant risk factors for SS were found to be smoking habit, BMI <25, preoperative anaemia and duration of operation more than two hours. Conclusion: Specific optimization of the patients' preoperative condition is essential to reduce the risk of SSI following elective gastrointestinal surgery. Surveillance should be conducted and maintained in all hospitals to promote better surgical outcomes. Cessation of smoking, optimization of nutritional status, correction of anaemia and reduction of operation time should be associated with a lower incidence of SSI. Journal of Surgical Sciences (2012) Vol. 16 (2) : 71-75

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