Risk factors for wound infection following cesarean deliveries

Abstract

Independent risk factors for an early wound infection are obesity, diabetes, hypertension, premature rupture of membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates of wound infection should be provided to obese women undergoing cesarean delivery, especially when diabetes coexists.

Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

“…Previous studies that had sufficient sample sizes and that used multivariate analysis to identify independent risk factors for SSI after cesarean section identified the following factors associated with increased risk of SSI: younger age; obesity; presence of hypertension or preeclampsia; diabetes mellitus; chorioamnionitis; preoperative infection at a remote body site; high preoperative severity of illness; nulliparity; fewer than 7 prenatal visits; longer interval since rupture of membranes; premature rupture of membranes; emergency delivery; ab- sence of antibiotic prophylaxis; longer duration of operation; use of staples for skin closure; and twin delivery. 3,7,8,19 The wide variety of reported independent risk factors for SSI may be due to the variability in potential risk factors selected for analysis. Killian et al 3 included only a very small number of potential risk factors, whereas other studies included a more comprehensive collection.…”

“…Killian et al 3 included only a very small number of potential risk factors, whereas other studies included a more comprehensive collection. 7,8 Also, of the 4 studies that used multivariate analysis with sufficient sample size, 1 study conducted SSI surveillance only during the original surgical admission. 7 Our study of a university-affiliated tertiary care hospital obstetrics population undergoing low transverse cesarean section included women from a wide spectrum of society with regard to socioeconomic and health status.…”

“…7,8 Also, of the 4 studies that used multivariate analysis with sufficient sample size, 1 study conducted SSI surveillance only during the original surgical admission. 7 Our study of a university-affiliated tertiary care hospital obstetrics population undergoing low transverse cesarean section included women from a wide spectrum of society with regard to socioeconomic and health status. More than half the deliveries were performed by the university teaching service, including patients with low socioeconomic status and/or with severe maternal or fetal health conditions.…”

“…3,7,8,22 Possible biological explanations for this association include the relative avascularity of adipose tissue, 8,23 the increase in wound area, 24 and the poor penetration of prophylactic antibiotics in adipose tissue. 25 Our study calculated the BMI of patients from their weight and height at admission, because the prepregnancy BMI was not available for all patients.…”

“…1 The rates of SSI after cesarean section reported in the literature range from 3% to 15%, depending on the surveillance methods used to identify infections, the patient population, and the use of antibiotic prophylaxis. [2][3][4][5][6][7][8][9][10][11] The pooled mean rate of SSI after cesarean section for US hospitals participating in the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System is 3.15%. 12 Expanding our knowledge of the risk factors associated with SSI is essential to developing targeted prevention strategies to reduce the risk of SSI.…”