Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India

Abstract

BackgroundSurgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital.MethodsPatients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds.ResultsA total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%.ConclusionsIncidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecological surgeries. Multiple risk factors identified in the present study can be helpful for SSI risk stratification in low-middle income countries.

Prospective Analysis of Wound Infection Following Cesarean Section

“…In this study, the majority of cases (55%) of SSI were above 25years age and this was statistically signi cant. This was similar to studies conducted by Anjum et al and Wloch C.et al (2012), while a study was done by Olicer Ezechi et al (2009) in Nigeria showed 75% SSI cases below 25years age, replicating the outcomes from the study by Ashish Pathak et al (2017) in rural India [8][9][10]. A few have also reported an absence of any association between maternal age and SSI [3,18].…”

Surgical Site Infection Among Gynaecological and Obstetric Abdominal Surgeries.

“…In present study, the prevalence of surgical site infections among obstetric and gynaecological surgeries was 10%. In a study by Pathak et al [12], the cumulative incidence rate of SSI was 7.84% (95% CI 6.30-9.38) while Shahane V et al [10] and Nisa MN et al [14] observed the cumulative incidence as 6% and 6.5% respectively.…”

Prevalence of surgical site infections in general surgery in a tertiary care centre in Eastern India

“…An explanation for risk for SSI following blood transfusion remains unclear and probably reflects a proxy for severe anemia and consequent low oxygen carrying capacity and delivery to the tissues, potential contamination, and transfusion related immunomodulation in presence of critical illness. 33,34 A previous study showed a predominance of SSI in the age group >65 years compared to <65 years. 35 We found a significantly higher rate of SSI in emergency operations compared to routine elective surgeries, (11.9% versus 4.4%; P < 0.05).…”