Obstetric Surgical Site Infections

Ahmadzia, Homa K.; Patel, Emily; Joshi, Dipa; Liao, Caiyun; Witter, Frank R.; Heine, R. Phillips; Coleman, Jenell S.

doi:10.1097/aog.0000000000001064

Cited by 108 publications

(14 citation statements)

References 11 publications

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“…In evaluating the effectiveness of vac dressings, the primary goal was to assess the presence of a superficial incisional surgical site infection (SSI). Eleven studies assessed the use of cefazolin in perioperative prophylaxis [48][49][50][51][52][53][54][55][56][57][58], six of which were prospective [48,52,[54][55][56][57][58], and two were randomized and double-blind [51,53].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

Słabuszewska-Jóźwiak

Szymański

Jóźwiak

et al. 2021

JCM

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(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

Słabuszewska-Jóźwiak

Szymański

Jóźwiak

et al. 2021

JCM

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“… 41 Several recent studies comparing preoperative 2 g with 3 g cefazolin in morbidly obese gravid women before cesarean section found no difference in the rate of SSI or in the adipose tissue antibiotic concentration between the two regimens. 42 – 44 One trial did find higher adipose concentrations of cefazolin after administration of 3 g but did not evaluate the effect on SSI occurrence. 45 The American College of Obstetricians and Gynecologists, in its committee opinion, recommends antimicrobial prophylaxis for all cesarean deliveries unless the patient is already receiving an antibiotic regimen with appropriate coverage (eg, for chorioamnionitis).…”

Section: Prevention Strategiesmentioning

confidence: 99%

Postcesarean wound infection: prevalence, impact, prevention, and management challenges

Zuarez-Easton

Zafran

Garmi

et al. 2017

IJWH

149

147

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Surgical site infection (SSI) is one of the most common complications following cesarean section, and has an incidence of 3%–15%. It places physical and emotional burdens on the mother herself and a significant financial burden on the health care system. Moreover, SSI is associated with a maternal mortality rate of up to 3%. With the global increase in cesarean section rate, it is expected that the occurrence of SSI will increase in parallel, hence its clinical significance. Given its substantial implications, recognizing the consequences and developing strategies to diagnose, prevent, and treat SSI are essential for reducing postcesarean morbidity and mortality. Optimization of maternal comorbidities, appropriate antibiotic prophylaxis, and evidence-based surgical techniques are some of the practices proven to be effective in reducing the incidence of SSI. In this review, we describe the biological mechanism of SSI and risk factors for its occurrence and summarize recent key clinical trials investigating preoperative, intraoperative, and postoperative practices to reduce SSI incidence. It is prudent that the surgical team who perform cesarean sections be familiar with these practices and apply them as needed to minimize maternal morbidity and mortality related to SSI.

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“…For women with (BMI >30 kg/m 2 or weight > 100 kg, a dose of 2 g cefazolin intravenous infusion is recommended [40]. Though use of higher doses have been considered in women with BMI > 40 kg/m 2 , one retrospective study of morbidly obese women did not demonstrate a difference in SSIs comparing cefazolin doses of 2 g and 3 g [41]. …”

Section: Preoperative Managementmentioning

confidence: 99%

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Kawakita

Landy

2017

matern health, neonatol and perinatol

164

105

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Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD – 2-7% will experience sound infections and 2-16% will develop endometritis. Many risk factors for SSI have been described. These include maternal factors (such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis; emergency delivery; and excessive blood loss), and obstetrical care on the teaching service of an academic institution. Effective interventions to decrease surgical site infection include prophylactic antibiotic use (preoperative first generation cephalosporin and intravenous azithromycin), chlorhexidine skin preparation instead of iodine, hair removal using clippers instead of razors, vaginal cleansing by povidone-iodine, placental removal by traction of the umbilical cord instead of by manual removal, suture closure of subcutaneous tissue if the wound thickness is >2 cm, and skin closure with sutures instead of with staples. Implementation of surgical bundles in non-obstetric patients has been promising., Creating a similar patient care bundle comprised evidence-based elements in patients who undergo CD may decrease the incidence of this major complication. Each hospital has the opportunity to create its own CD surgical bundle to decrease surgical site infection.

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Obstetric Surgical Site Infections

Abstract: III.

Cited by 108 publications

References 11 publications

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

Postcesarean wound infection: prevalence, impact, prevention, and management challenges

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

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