Prospective Cohort Study of Surgical Site Infections Following Single Dose Antibiotic Prophylaxis in Caesarean Section at a Tertiary Care Teaching Hospital in Medchal, India

Abstract

Background: Caesarean section (CS) is a considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following Caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial sensitivity and resistance pattern of the culture positive isolates Main objectives: To estimate the incidence of surgical site infections (SSIs) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for Caesarean section at a tertiary care teaching hospital in Medchal, India. Methods: A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent Caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. Results: The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n=1,274, 63.2%) and underwent emergency Caesarean delivery (n=1,226, 60.8%). Of these, 92 participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (aRR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; Power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; Power 100%) among women aged 25 years or younger. Microbial growth was observed in 75.8% (n=50/66) samples. The most common organisms identified were Staphylococcus aureus (n=23, 46.0%), Klebsiella sp. (n=13, 26.0%), and Escherichia coli (n=12, 24.0%). Conclusion: Given the low rate of SSI following Caesarean deliveries subjected to single-dose antibiotic prophylaxis and the increased risk noted with obesity, it is rationale to practice the latest recommendations of WHO including higher dose for obese patients, unless there is compelling evidence to do otherwise in any context.