Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study

Abstract

Introduction Post cesarean section surgical site infection increases both the duration of a patient’s hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities. Method Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers’ who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model. Result Age 20–34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection. Conclusion Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Magnitude and factors associated with surgical site infections post caesarian sections in an urban district hospital, Kigali-Rwanda

“…With this current study, mothers aged 35 and over were ve times more likely to develop SSIs post-CS than their counterparts AOR = 5.12 (95%CI: 1.10-23.95), p = 0.038. This study's nding was consistent with the study done in Ethiopia, where the odds of mothers aged 20-34 and ≥ 35 were ve times and nine times more likely to have SSI post-CS compared to those aged ≤ 19 years(AOR: 5.4; 95%CI: 2.35, 12.7), (AOR: 8.9; 95%CI: 1.8,43.9) respectively [25]. This might be due to the physiological changes resulting from ageing and the frailty of resisting infection in general [44].…”

“…Risk factors for SSI post-CS Surgical site infections post-obstetrical surgeries are commonly associated with obesity/overweight and smoking [24], complicated deliveries/ prolonged labour/operation duration, rupture of membranes as well as younger aged mothers [1,4,6,25], effective use of antibiotics, pre-operative optimization, medical management of pregnancy-related conditions and other comorbidities, peri-operative behaviors, surgical techniques, septic operations, emergency procedures, [12,13,26]. Poor nutrition, coexisting infections, and comorbid factors like retroviral diseases, diabetes, and exposure to irradiation effects [4].…”

Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

“…This is presumably due to the long duration of prophylaxis [41]. Some other studies have indicated that emergency CS deliveries have been linked to SSIs, due to highly urgent operations with fewer concerns about sterility and the absence of prophylactic antibiotics administered on time [31] [42] [43] [44]. This is similar to what was found in our study, in which we demonstrated a greater association between elective CS delivery and no surgical site infections as compared with emergency CS deliveries.…”

“…Our study demonstrated that 56% of women who underwent CS delivery were from low-cost residential areas, similar to other studies [12] [28] [31]. It was also determined that all the patients who had CS delivery received perioperative anti-biotic prophylaxis and anaesthetic.…”

Post-Caesarean Wound Infections: Incidence, Bacterial Profiles, Antimicrobial Susceptibility Patterns and Associated Factors in Public Hospitals, Southern Ethiopia

“…A scan of the literature indicated that in Ethiopia, only limited data exist which describe the epidemiology of PSWI, the causative organisms, or the incidence of antimicrobial drug resistance, and often, there is no information linked to the post-discharge surveillance programs. Furthermore, risk factors linked to PSWI, too, showed wider variations in several Ethiopian studies [13][14][15][16][17]. In addition, the incidence of infections may vary, depending on the surgeon, hospital, surgical procedures applied, and patient.…”