Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

Abstract

Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

“…It has also been observed that the incidence of SSIs increases with the age of the patients (16-19: 0%; 20-34: 0.7%; 35 or older: 3.3%). Thus, a signi cant relationship was found between these variables (Chisq = 8.08, P = 0.036), which is in line with similar data reported in other studies [31][32][33]. In contrast, no association was found between patient age and PAP administration (Chisq=1.59, P=0.44).…”

“…Unfortunately, little research addresses the issue of costs of noncompliance with the PAP in caesarean sections. Instead, studies generally address the average cost of a patient receiving PAP and how cost-effective it is compared to a patient who does not receive it [32][33][34]. Jansson et al found 99% savings from compliance with the PAP, [35] which is even higher than what was found in the present research.…”

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

“…The incidence of SSI in this study (1.35%) is lower than in other similar studies, where it reaches up to 40% [29][30][31][32][33]. In patients who were not given PAP, the incidence of SSIs was higher than in those who received pre-surgical antibiotics (1.63% vs 1.23%).…”

Maternal caesarean section infection (MACSI) in Sierra Leone: a case–control study

“…It is known that prophylactic antibiotics work synergistically with the appropriate antiseptic measures before and during surgery [22,23], so such factors might also have impacted the observed low SSI rate. Indeed, it is widely recognised that infection prevention requires the integration of a range of control procedures before, during and after surgery [24][25][26][27]. We found that the high rate of incomplete antibiotic dosing was an important predictor of infection, resulting in a two and half fold increase of infection risk for each missed dose.…”