Aim and objective: To find the incidence of surgical site infections following cesarean section and to assess the associated risk factors and the common pathogens involved in these wound infections.
Materials and methods: The study was conducted from November 2014 to June 2016. A total of 548 women were included. Data were collected from patients and medical records in a semi-structured proforma and wound site examined till discharge of the patients. After discharge, patients were followed by telephone on day 14 and 30.
Results: The mean age of the women was 26.20 ± 4.385 years. The mean BMI was 25.965 ± 4.18 kg/m2. Forty women out of the total 548 developed surgical site infections with an incidence rate of SSI of 7.3%. Only three cases in them were deep SSI. Gram-negative organisms were the most isolated organisms in the infected cases with Escherichia coli being the most common organism. The key risk factors for infections found significant by multiple logistic regression analysis were obesity, severe anemia, prolonged rupture of membranes, multiple vaginal examinations, emergency basis, extended duration of surgery, and skin closure by mattress sutures with silk sutures.
Conclusion: The infection rate is significantly associated with severe anemia and obesity, prolonged rupture of membranes, multiple vaginal examinations, emergency procedures, prolonged duration of surgery, and silk as a suture material for skin closure with mattress suture.
Ezechi OC, Fasubaa OB, Dare FO. Socioeconomic barrier to safe motherhood among booked patients in rural Nigerian communities. J Obstet Gynaecol 2000;20(1):32–34. DOI: 10.1080/01443610063426.
Ward VP, Charlett A, Fagan J, et al. Enhanced surgical site infection surveillance following cesareansection: experience of a multicentre collaborative post-discharge system. J Hosp Infect 2008;70(2): 166–173. DOI: 10.1016/j.jhin.2008.06.002.
Moir-Bussy BR, Hutton RM, Thompson JR. Wound infection after cesarean section. J Hosp Infect 1984;5(4):359–370. DOI: 10.1016/0195-6701(84)90003-3.
Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections 1992: a modification of surgical wound infections. Infect Control Hosp Epidemiol 1992;13(10):606–608. Doi: 10.1016/s0196-6553(05)80201-9
Kinsella SM, Scrutton MJL. Assessment of a modified four-category classification of urgency of cesarean section. J Obstet Gynaecol 2009;29(2):110–113. DOI: 10.1080/01443610802585546.
Emori TG, Gaynes RR. An overview of nosocomial infections, including the role of the microbiology lab. Clin Microbiol Rev 1993;6(4):428–444. DOI: 10.1128/CMR.6.4.428.
De D, Saxena S, Mehta G, et al. Risk factor analysis and microbial etiology of surgical site infections following lower segment cesarean section. Int J Antibiot 2013;2013:1–6. DOI: 10.1155/2013/283025.
Shrestha S, Shrestha R, Shrestha B, et al. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital. Kathmandu Univ Med J 2014;46(2):113–116. DOI: 10.3126/kumj.v12i2.13656.
Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of Jimma University specialized hospital, southwest Ethiopia. Ethiop J Health Sci 2011;21(2):91–100. DOI: 10.4314/ejhs.v21i2.69049.
Talukdar RK, Gharphalia DJ, Acharjee U. Surgical site infection following emergency LSCS – to find out the incidence, risk factors and commonly associated bacteria. Sch J Appl Med Sci 2015;3(8A):2794–2801.
Olsen MA, Butler AM, Willers DM, et al. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008;29(6):477–484. DOI: 10.1086/587810.
Ghuman M, Rohlandt D, Joshy G, et al. Post cesarean section surgical site infection: rate and risk factors. N Z Med J 2011; 124(1339):32–36.
Johnson A, Young D, Reilly J. Cesarean section surgical site infection surveillance. J Hosp Infect 2006;64(1):30–35. DOI: 10.1016/j.jhin.2006.03.020.
Tran TS, Jamulitrat S, Chongsuvivatwong V, et al. Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95(3): 367–371. DOI: 10.1016/s0029-7844(99)00540-2.
Ansar A. Surgical site infection in obstetrics practice. Pak J Surg 2013;18(2):68–73.
Islam A, Ehsan A. Comparison of suture material and technique of closure of subcutaneous fat and skin in cesarean section. N Am J Med Sci 2011;3(2):85–88. DOI: 10.4297/najms.2011.385.
Metgud MC, Kataria A, Nadipally SR, et al. Incidence of wound dehiscence following obstetric and gynecological surgeries at a Tertiary Care Hospital: a retrospective study. J South Asian Feder Obstet Gynaecol 2020;12(2):73–78. DOI: 10.5005/jp-journals-10006-1763.
Abbey R, Mohan M, Malik N, et al. Surgical site infections in a rural teaching hospital of North India. Int J Adv Integ Med Sci 2017;2(1): 11–16. DOI: 10.5005/jp-journals-10050-10066.