Immediate postpartum glycemic control and risk of surgical site infection

Abstract

In our cohort of diabetic women who underwent cesarean delivery, immediate postoperative hyperglycemia was not associated with wound morbidity.

Evaluation of risk factors for surgical site infection after cesarean section

“…In the study evaluating the relationship between postpartum glycemic control and SSI, mean blood glucose levels were higher in the SSI group. On the other hand, in the same study, they could not definitely show its association with SSI and finally reported that instantaneous increases in blood glucose levels were not predictive for SSI [8]. When patients with and without postoperative SSI following CS were compared, neither the frequency of diabetes mellitus nor GDM were significantly different from each other in another study [13].…”

“…Similarly, Haidar et al [2] reported the incidence of SSI following CS as 6.5%. In the study of Johnston et al [8], SSI following CS was 16.5%. The data from our country about CS-related SSI is quite limited.…”

“…Hyperglycemia, known to be associated with disturbed angiogenesis, leads to impairment in wound healing. The interaction of glucose with several growth factors may be responsible for increased risk of SSI [8]. Diabetes has been a widely accepted risk factor for SSI in past decades.…”

“…The SSI after CS can be affected by patient and health care providers characteristics and perioperative conditions [8]. Many risk factors have been claimed for SSI after CS, which include obesity, diabetes mellitus, hypertension, multiple pregnancies, tobacco use, previous CS, labor induction, presence of chorioamnionitis, large incision, long operation time, steroid use, thick subcutaneous tissue, emergent cesarean delivery and inadequate or inappropriate antibiotic prophylaxis [1,7].…”

Future Directions to Limit Surgical Site Infections

“…In particular, hyperglycemia has been shown to be associated with SSI not only in diabetic patients (with constant hyperglycemia) but also in those patients who develop stress hyperglycemia after surgery [11], and control of blood glucose levels can reduce SSI by 50% [12]. Blood glucose levels impact wound healing by interfering with angiogenesis through modulation of growth factors and cytokines such as vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-b), platelet-derived growth factor (PDGF), and soluble fms-like tyrosine kinase 1 (sFlt-1) [13,14]. Authors have confirmed that these alterations in wound healing are increasingly complex and can also involve phagocytosis, chemotaxis, blood vessel adhesion, bactericidal activity of granulocytes, collagen synthesis, and fibroblast proliferation.…”