Abstract:

Background: The post caesarean section surgical site infection in the second most common infectious complication after urinary tract infection following caesarean section delivery. The report incidence of surgical-site infections following caesarean section varies widely depending on the surveillance methods, criteria used to define SSI, post-operative hospital stays, antibiotic prophylaxis and the patient population. At Bugando Medical Centre there has not been a study which documented the incidence, independent risk factors and susceptility pattern of bacterial isolates for surgical site infection (SSI) after caesarean section despite the large number of caesarean sections performed and the relatively common occurrence of SSI.

Methods: This was a prospective cohort study involving pregnant women who underwent caesarean section from October 2011 to February 2012 at Bugando Medical Centre. A Total of 345 pregnant women who met inclusion criteria were serially recruited into the study, Pre-operative, intra-operative and post-operative data were collected using standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was done using disc diffusion technique. Data were analyzed using STATA version 11.

Results: The overall cumulative incidence of SSI was 10.9% with incidence rate of 37.5 per 10,000 persons-days (95% CI, 26.8-52-4). The median time from CS and development of surgical site infections was 7 days (Interquartile range [IQR] = 6-9 days). Six independent risk factors for post caesarean SSI identified in this study by multivariate analysis: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; p=0.21); severe anaemia (HR: 3.8; 95% CI, 1.2-12.4; p=0.028), surgical wound class III (HR:2.4; 95% CI, 1.1-5.0; p=0.021), multiple vaginal examinations (HR:2.5; 95% CI, 1.2-5.1; p=0.011), prolonged duration of operation (HR:2.6; 95% CI, 1.2-5.5; p=0.015) and an operation perfumed by an intern doctor (HR:4.0; 95% CI, 1.7-9.2; p=0.001). Staphylococcus aureus was the commonest organism, 6 (27.3%) followed by Klebsiella pneumonia 5 (22.7%). Gram positive bacteria were 100% sensitive to vancomycin. Most of gram negative bacteria were highly resistant to ampicillin (100%), sensitive to vancomycin. Most of gram negative bacteria were highly resistant to ampicillin (100%) amoxillin/clavulanate (93%), sulphamethaxazole/trimethoprim (78.5%), fosfomycin (70%), tetracycline (70%) and gentamicin (35.7%) they were 100%, 85.7%, 85.7% and 78% sensitive to meropenem, ceftazidime, ciprofloxacin and ceftriaxone respectively. Patient with SSI had a longer mean hospital stay than those without SSI (12.7±6.9 vs. 4±1.7; p<0.0001) and the case fatality rate among patients with SSI was 2.9%.

Conclusions: Surgical site infections are common among women undergoing caesarean section at Bugando Medical Centre. SSI were significantly associated with operation performed by an intern doctor, prolonged duration of operation, multiple vaginal examinations, contaminated wound, severe anaemia, and hypertensive disorders of pregnancy. Surgical site infections caused by bacteria resistant to commonly used antibiotics is common among women undergoing caesarean section at BMC. Strategies to control these factors are urgently needed to control SSI post CS at Bugando Medical Centre and other centres in developing countries.