Incidence of Post-cesarean Section Wound Infections in Emergency and Elective Cases at a Tertiary Healthcare Center in Egypt

Ahmed A. Hussein; Muhammad M. Jebril; Muhamed A. Abdelmoaty

doi:10.18502/dmj.v8i2.19006

المؤلفون

Ahmed A. Hussein Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo
Muhammad M. Jebril Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo
Muhamed A. Abdelmoaty Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Cairo https://orcid.org/0000-0003-4206-2157

DOI:

https://doi.org/10.18502/dmj.v8i2.19006

الكلمات المفتاحية:

post cesarean section، wound infections، emergency CS، elective CS، SSI

الملخص

Introduction: Infections at the site of a cesarean section (CS) can lead to longer hospital stays, increased medical costs, and a range of other health complications, including higher mortality rates. For women who experience postoperative wound infections, the recovery process after a cesarean delivery becomes significantly more challenging.

Objectives: The purpose of this study was to compare the incidence of postoperative wound infections between emergency and elective cesarean cases at a tertiary healthcare center in Egypt.

Patients and Methods: This prospective cohort study included 220 patients who underwent either elective or emergency CSs. The patients were divided into two groups: those who underwent emergency CSs and those who underwent elective CSs. Each patient was monitored for 8 weeks post-surgery, with regular wound inspections. An audit form was used to document the occurrence of both minor and major wound infections to track infection rates.

Results: Surgical site infections (SSIs) were identified in 28 patients. Of these, 13 patients (11.82%) were in the emergency CS group, and 15 patients (13.64%) were in the elective CS group. The difference in infection rates between the two groups was not statistically significant. Multiple logistic regression analysis identified rural residence, hypertension, membrane rupture, general anesthesia, blood loss ≥500 ml, and low postoperative hemoglobin levels as significant independent predictors for the incidence of SSIs (P < 0.05).

Conclusion: The study identified significant independent predictors of postoperative SSIs following CSs, including rural residence, hypertension, membrane rupture, general anesthesia, blood loss ≥500 ml, and low postoperative hemoglobin levels. Furthermore, no significant difference in the risk of SSI was observed between emergency and elective CSs.

المراجع

[1] Shea SK, Soper DE. Prevention of cesarean delivery surgical site infections. Obstet Gynecol Surv. 2019 Feb;74(2):99–110. DOI: https://doi.org/10.1097/OGX.0000000000000645

[2] Gomaa K, Abdelraheim AR, El Gelany S, Khalifa EM, Yousef AM, Hassan H. Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study. BMC Pregnancy Childbirth. 2021;21(1):634. DOI: https://doi.org/10.1186/s12884-021-04054-3

[3] Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the good, the bad and the ugly. J Perinat Med. 2020;49(1):5–16. DOI: https://doi.org/10.1515/jpm-2020-0305

[4] Tita AT, Szychowski JM, Boggess K, Saade G, Longo S, Clark E, et al. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2016;375(13):1231–1241. DOI: https://doi.org/10.1056/NEJMoa1602044

[5] Li L, Cui H. The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis. BMC Surg. 2021;21(1):248. DOI: https://doi.org/10.1186/s12893-021-01154-x

[6] Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: a systematic review and meta-analysis. Int J Gynaecol Obstet. 2022 Sep;158(3):502–511. DOI: https://doi.org/10.1002/ijgo.14058

[7] Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. Int J Womens Health. 2017;9:81–88. DOI: https://doi.org/10.2147/IJWH.S98876

[8] Altman AD, Allen VM, McNeil SA, Dempster J. Pfannenstiel incision closure: a review of current skin closure techniques. J Obstet Gynaecol Can. 2009 Jun;31(6):514–520. DOI: https://doi.org/10.1016/S1701-2163(16)34213-X

[9] Jasim HH, Sulaiman SA, Khan AH, Dawood OT, Abdulameer AH, Usha R. Incidence and risk factors of surgical site infection among patients undergoing cesarean section. Clinical Medicine Insights: Therapeutics. 2017;9:1–7. DOI: https://doi.org/10.1177/1179559X17725273

[10] Abdelraheim AR, Gomaa K, Ibrahim EM, Mohammed MM, Khalifa EM, Youssef AM, et al. Intra-abdominal infection (IAI) following cesarean section: A retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy Childbirth. 2019 Jul;19(1):234. DOI: https://doi.org/10.1186/s12884-019-2394-4

[11] Carbonnel M, Brot D, Benedetti C, Kennel T, Murtada R, Revaux A, et al. Risks factors FOR wound complications after cesarean section. J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):101987. DOI: https://doi.org/10.1016/j.jogoh.2020.101987

[12] Abdallah A, Rafeek ME. Risk factors of surgical site infection of cesarean section and role of skin cleansing and prophylactic antibiotic. Int J Reprod Med Gynecol. 2018;4(2):47–51.

[13] Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023 May;44(5):695–720. DOI: https://doi.org/10.1017/ice.2023.67

[14] Azeze GA, Gelaw KA, Gebeyehu NA, Gesese MM, Mokonnon TM. Exclusive breastfeeding practice and associated factors among mothers in Boditi Town, Wolaita Zone, Southern Ethiopia. A communitybased cross-sectional study. Int J Pediatr. 2019;2019:1483024. DOI: https://doi.org/10.1155/2019/1483024

[15] Scholz R, Smith BA, Adams MG, Shah M, Brudner C, Datta A, et al. A multifaceted surgical site infection prevention bundle for cesarean delivery. Am J Perinatol. 2021 Jun;38(7):690–697. DOI: https://doi.org/10.1055/s-0039-3400993

[16] Odada D, Shah J, Mbithi A, Shah R. Surgical site infections post cesarean section and associated risk factors: A retrospective case-control study at a tertiary hospital in Kenya. Infect Prev Pract. 2023;6(1):100333. DOI: https://doi.org/10.1016/j.infpip.2023.100333

[17] Mezemir R, Olayemi O, Dessie Y. Incidence, bacterial profile and predictors of surgical site infection after cesarean section in Ethiopia, a prospective cohort study. Int J Womens Health. 2023;15:1547– 1560. DOI: https://doi.org/10.2147/IJWH.S425632

[18] Abdallah AA, Taha RR, Saad AK. Prevalence and indicators of post cesarean surgical site infection in Minia maternity university hospital. MJMR. 2019;30(4):260–265. DOI: https://doi.org/10.21608/mjmr.2022.221736

[19] Rose AF, Fekad B, Moore JN, Graham WJ. Post-caesarean section surgical site infections: A retrospective audit and case note review at an Ethiopian referral hospital. Obstet Gynecol Rep. 2018;2(2):1–6. DOI: https://doi.org/10.15761/OGR.1000126

[20] Getaneh T, Negesse A, Dessie G. Prevalence of surgical site infection and its associated factors after cesarean section in Ethiopia: Systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20(1):311. DOI: https://doi.org/10.1186/s12884-020-03005-8

[21] Dessu S, Samuel S, Gebremeskel F, Basazin A, Tariku Z, Markos M. Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study. PLoS One. 2021;16(4):e0250174. DOI: https://doi.org/10.1371/journal.pone.0250174

[22] Wondmeneh TG, Mohammed JA. The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne). 2024;11:1395158. DOI: https://doi.org/10.3389/fmed.2024.1395158

[23] Adane A, Gedefa L, Eyeberu A, Tesfa T, Arkew M, Tsegaye S, et al. Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: A prospective cohort study. Ann Med Surg (Lond). 2023 Mar;85(4):738–45. DOI: https://doi.org/10.1097/MS9.0000000000000411

[24] Ali O, Kassahun D, Rade BK, Atnafu A. Maternal factors are important predictors for surgical site infection following cesarean section in Northwest Ethiopian. Clin Epidemiol Glob Health. 2022;13:100936. DOI: https://doi.org/10.1016/j.cegh.2021.100936

[25] Alemye T, Oljira L, Fekadu G, Mengesha MM. Post cesarean section surgical site infection and associated factors among women who delivered in public hospitals in Harar city, Eastern Ethiopia: A hospital-based analytic cross-sectional study. PLoS One. 2021;16(6):e0253194. DOI: https://doi.org/10.1371/journal.pone.0253194