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Sibomana O, Bugenimana A, Oke GI, Egide N. Prevalence of post-caesarean section surgical site infections in Rwanda: A systematic review and meta-analysis. Int Wound J 2024; 21:e14929. [PMID: 38772859 PMCID: PMC11108763 DOI: 10.1111/iwj.14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
Caesarean section (C-section) is the most performed major surgery worldwide. About 15% of births are delivered through C-section in Rwanda. The post-caesarean surgical section is one of the most frequent complications that follow a C-section. The purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of surgical site infections following caesarean section deliveries in Rwanda. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, DOAJ, AJOL and the Cochrane Library to identify primary studies on post-caesarean surgical site infections in Rwanda. Studies meeting predetermined criteria were included, and their quality was assessed using the JBI Critical Appraisal Tools. Heterogeneity was evaluated using I2 statistics, while publication bias was examined via funnel plots and statistical tests. Pooled prevalence was calculated using Jamovi 2.3.28 software, with subgroup analysis conducted to identify sources of heterogeneity. Statistical significance was set at p < 0.05. From 139 articles initially searched from the databases, only 17 studies with 8, 082 individuals were finally included in the systematic review and meta-analysis. Using the random-effects model, the pooled estimate of post C-section SSIs prevalence in Rwanda was 6.85% (95% CI 5.2, 8.5). Subgroup analysis based on publication year, sample size, hospital and study design showed no much difference in SSI prevalence. The current systematic review and meta-analysis indicates that post-caesarean surgical site infections are significant in Rwanda. A collaborative effort is required to lower post-C-section SSIs and provide the best surgical care in the country.
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Affiliation(s)
- Olivier Sibomana
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Athanasie Bugenimana
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Ndayambaje Egide
- Department of General Medicine and Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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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. [PMID: 38725468 PMCID: PMC11079214 DOI: 10.3389/fmed.2024.1395158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Background Although surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia. Methods We searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out. Results Twenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96-16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15-3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24-2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45-6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22-2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54-4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93-5.92) were independent risk factors for surgical site infections. Conclusion More than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.
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Lake ES, Alamrew A, Belay WS, Yilak G, Berihun Erega B, Abita Z, Ayele M. Surgical site infection following cesarean section and its predictors in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0296767. [PMID: 38512861 PMCID: PMC10956825 DOI: 10.1371/journal.pone.0296767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/18/2023] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Worldwide, surgery related deaths within 30 days of the procedure accounts the third contributor among all causes of deaths, with an estimated 4.2 million people annually and half of these deaths occur in low and middle income countries. OBJECTIVE To determine the pooled prevalence of surgical site infection following cesarean section and its predictors in Ethiopia. METHODS A systematic review and meta-analysis were conducted by using PRISMA guideline. An appropriate and comprehensive search of PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI and Scopus was done. This SRMA included all articles conducted in all regional state of Ethiopia reporting the prevalence/proportion/incidence of SSI after cesarean section and/or associated factors. All observational study designs were included in this SRMA. Articles which lack our outcome of interest: SSI following cesarean section and its predictors were excluded from this SRMA. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of SSI. Adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 17 software. RESULT Initially 6334 studies were identified and finally 19 studies were found eligible for the analysis. Studies with a score of 7 and above were included for the final systematic review and meta-analysis. The review was comprised of 14 cross sectional studies, 4 cohort and one case control studies. The pooled estimate of SSI in Ethiopia was 11.13% (95%CI, 9.29-12.97%). Prolonged labor (AOR = 3.16, 95% CI; (2.14-4.68)), chorioamnionitis (AOR = 4.26, 95% CI; (1.99-8.91)), prolonged PROM (AOR = 3.80, 95% CI; (2.51-5.62)), repeated vaginal examination (AOR = 3.80, 95% CI; (2.45-5.88)), decreased hemoglobin level (AOR = 4.57, 95%CI; (3.16-6.60)), vertical skin incision (AOR = 3.09, 95% CI; (2.04-4.67)) and general anesthesia (AOR = 1.82, 95% CI (1.21-2.75)) are significantly associated with SSI after cesarean section in Ethiopia. CONCLUSION SSI after cesarean section in Ethiopia is high. Prolonged labor, chorioamnionits, prolonged PROM, repeated vaginal examination, decreased Hgb level, vertical skin incision and general anesthesia were positively associated. Thus, evidence based intra-partum care should be practiced.
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Affiliation(s)
- Eyob Shitie Lake
- School of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Abebaw Alamrew
- School of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Wagaye Shumete Belay
- School of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Gizachew Yilak
- Department of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Besfat Berihun Erega
- School of Midwifery, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zinie Abita
- School of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Mulat Ayele
- School of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
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Fixler JS. Surgical-site infection in multifetal cesarean delivery. Arch Gynecol Obstet 2024:10.1007/s00404-024-07384-7. [PMID: 38448709 DOI: 10.1007/s00404-024-07384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/07/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The relationship between multifetal cesarean delivery and surgical-site infection (SSI) is unclear. If SSI is more common in multifetal cesareans, adjustment of practices such as antibiotic dosing could be warranted. The purpose of this study was to determine whether patients undergoing multifetal cesarean delivery are more likely to experience SSI than those undergoing singleton cesarean delivery. METHODS This was a retrospective cohort study including all cesarean deliveries at a tertiary hospital from 10/1/2009 to 12/28/2018. The primary outcome was rate of SSI in women after multifetal cesarean delivery as compared to those who underwent singleton cesarean delivery. Univariable analysis and multivariable logistic regression were used to assess independent clinical factors associated with SSI in multifetal cesarean deliveries. RESULTS 34,340 women underwent cesarean delivery during this period. 33,211 were singletons (96.7%), and 1,129 were multifetal (3.3%). There was no difference in the rate of SSI in multifetal gestations (15/1,129, 1.3%) as compared to singletons (493/33,211, 1.5%) (p = 0.670, OR 0.89 [95% CI 0.53, 1.50], aOR 1.06 [95% CI 0.61, 1.84]). Limiting analysis to multifetal deliveries, prolonged rupture of membranes (p < 0.004, OR 5.43 [95% CI 1.49, 19.88]), labor augmentation (p < 0.001, OR 15.84 [1.74, 144.53]), and chorioamnionitis (p < 0.001, OR 15.43 [95% CI 3.11, 76.62]) were more common in women with SSI. DISCUSSION SSI is not increased in multifetal cesarean delivery as compared to singleton cesarean delivery. In multifetal cesareans, chorioamnionitis, prolonged rupture of membranes, and labor augmentation were associated with increased odds of SSI.
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Affiliation(s)
- Joseph S Fixler
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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Cozzi GD, Ye Y, Mbah R, Mbunwe DM, Pekwarake S, Yui Bunwi E, Fondzeyuf A, Ngong MG, Dionne JA, Harper LM, Jauk VC, Carlo WA, Halle-Ekane G, Tih PM, Szychowski JM, Tita AT, Subramaniam A. Predicting peripartum infection in laboring patients at high risk in Cameroon, Africa. Eur J Obstet Gynecol Reprod Biol 2024; 293:9-14. [PMID: 38096705 DOI: 10.1016/j.ejogrb.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a predictive model for peripartum infection among high risk laboring patients in Cameroon, Africa. STUDY DESIGN We conducted a secondary analysis of the Cameroon Antibiotic Prophylaxis Trial (NCT03248297), a multicenter 3-arm double-blind randomized controlled trial of oral azithromycin ± amoxicillin among term pregnancies with prolonged labor or rupture of membranes in Cameroon 1/2018-5/2020. Patients with chorioamnionitis prior to randomization, study drug contraindications, or planned cesarean were excluded. The outcome of interest was a composite of maternal peripartum infection (chorioamnionitis, endometritis, sepsis by World Health Organization criteria, wound infection/abscess) diagnosed up to 6 weeks postpartum. Potential predictors were compared between patients with and without the composite outcome, and evaluated at a 0.05 alpha level. Statistically significant exposures were analyzed using multivariable regression (to generate adjusted odds ratios and 95 % confidence intervals) with backwards selection to generate a parsimonious model. Receiver operating characteristic curves with associated area under the curve assessed the model's predictive ability. A nomogram based on the final best fit multivariable model was constructed. RESULTS Of 756 patients in the parent trial, 652 were analyzed: 45 (7 %) had peripartum infection. Those with infection were more likely to be nulliparous, lower education level, higher gestational age, receive antibiotics per hospital protocols, and undergo cesarean. In our best-fit multivariable model, none/primary education (vs university), cesarean birth, and antibiotic receipt per physician discretion (vs for cesarean prophylaxis) were significantly associated with increased infection risk. This model was moderately predictive (AUC = 0.75, 95 % CI 0.67-0.82). When using this 3 factor model, for a patient with a cesarean birth, receipt of antibiotics per physician discretion, and university education, the probability of peripartum infection was 35 % (95 % CI 0.11-0.73). CONCLUSIONS While several variables such as parity are associated with infectious morbidity within 6 weeks among high risk laboring patients in Cameroon, only education level, antibiotic indication, and cesarean birth were independently associated, and a model including these 3 factors was moderately predictive. Validation of our findings in a larger population is warranted.
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Affiliation(s)
- Gabriella D Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Yuanfan Ye
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rahel Mbah
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Doreen M Mbunwe
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | | | - Edwan Yui Bunwi
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | | | - Mary G Ngong
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Jodie A Dionne
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Department of Women's Health, Division of Maternal Fetal Medicine, University of Texas at Austin, Dell School of Medicine, Austin, TX, USA
| | - Victoria C Jauk
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Halle-Ekane
- Cameroon Baptist Convention Health Services, Cameroon, Africa; University of Buea, Cameroon, Africa
| | - Pius M Tih
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Sheikh I, Fuller KA, Addae-Konadu K, Dotters-Katz SK, Varvoutis MS. The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes. Am J Perinatol 2024; 41:349-354. [PMID: 34710942 DOI: 10.1055/a-1682-2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. STUDY DESIGN The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9, 50-59.9, 60-69.9, and >70 kg/m2). RESULTS Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50-59.9 kg/m2; 13.7% BMI: 60-69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50-59.9 kg/m2; 6.2% for BMI: 60-69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35-4.02 for BMI 50-59.9 kg/m2; aOR = 4.91, 95% CI: 2.07-11.7 for BMI of 60-69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45-176 for BMI >70 kg/m2). CONCLUSION Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. KEY POINTS · Women with super obesity have higher rates of wound complications.. · Women at extremes of obesity experience worse postpartum infectious morbidity.. · More research is needed on effective strategies to minimize morbidity in this population..
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Affiliation(s)
- Iqra Sheikh
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
| | - Kylie A Fuller
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
| | | | | | - Megan S Varvoutis
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
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Basany K, Chaudhuri S, Shailaja P. L, Agiwal V, Angaali N, A. Y. N, D. S, Haggerty C, Reddy PS. Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India. PLoS One 2024; 19:e0286165. [PMID: 38271389 PMCID: PMC10810521 DOI: 10.1371/journal.pone.0286165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Caesarean section (CS) is 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 susceptibility pattern of the culture positive isolates. MAIN OBJECTIVES To estimate the incidence of surgical site infections (SSI's) 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 = 1,232, 61.1%). Ninety two 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 (a RR) 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 in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). CONCLUSION The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.
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Affiliation(s)
- Kalpana Basany
- Department of Obstetrics and Gynecology, Society for Health Allied Research and Education, INDIA MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sirshendu Chaudhuri
- Department of Epidemiology, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Lakshmi Shailaja P.
- Department of Obstetrics and Gynecology, Fernandez Hospital, Hyderabad, Telangana, India
| | - Varun Agiwal
- Department of Epidemiology, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Neelima Angaali
- Department of Microbiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nirupama A. Y.
- Department of Epidemiology, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Shailendra D.
- Department of Pharmacology, SHARE INDIA, MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Catherine Haggerty
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - P. S. Reddy
- Department of Obstetrics and Gynecology, Society for Health Allied Research and Education, INDIA MediCiti Institute of Medical Sciences, Hyderabad, Telangana, India
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
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Dong H, Song J, Jia Y, Cui H, Chen X. A comprehensive study on the risk factors and pathogen analysis of postoperative wound infections following caesarean section procedures. Int Wound J 2024; 21:e14609. [PMID: 38272798 PMCID: PMC10801270 DOI: 10.1111/iwj.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Postoperative wound infections (PWIs), a subtype of surgical site infections, are a significant concern for patients undergoing caesarean sections (C-sections). Understanding risk factors and pathogen profiles can greatly assist in early diagnosis and effective treatment. This study aimed to identify risk factors and analyse the pathogenic landscape contributing to PWIs in C-sections. A nested case-control study was carried out, utilising stringent criteria for case selection and control matching. Diagnostic criteria for surgical site infections included both clinical and microbiological parameters. Risk variables examined included patient age, Body Mass Index, duration of surgery and several other clinical indicators. Microbiological analysis was performed using the BD Phoenix-100 Automated Bacterial Identification System. Statistical analyses were conducted using SPSS version 26.0, and risk factors were evaluated through both univariate and multivariate analyses. A total of 50 patients, aged between 20 and 45 years (mean age 26.3 ± 5.6), developed PWIs following C-sections. The study revealed a temporal distribution and various clinical indicators of PWIs, including elevated white blood cell count and C-reactive protein levels. Gram-negative bacteria were found to be more prevalent at 57.4%. Notable pathogens included Pseudomonas aeruginosa and Acinetobacter baumannii. Antimicrobial resistance patterns were also identified, highlighting the need for a targeted antibiotic approach. Increased infection risks were linked to lack of prophylactic antibiotics, absence of preoperative povidone-iodine antisepsis, operations over an hour, anaemia, amniotic fluid contamination, diabetes, GTI, premature rupture of membranes and white blood cells counts above 10 × 109 /L. The study provides critical insights into the risk factors and microbial agents contributing to PWIs following C-sections. Our findings emphasise the importance of early diagnosis through clinical and laboratory parameters, as well as the need for constant surveillance and reassessment of antibiotic stewardship programs.
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Affiliation(s)
- Hui Dong
- School of Medicine, Nankai UniversityTianjinChina
- Tianjin Key Laboratory of Human Development and Reproductive RegulationTianjinChina
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Jie Song
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
- Tianjin Medical UniversityTianjinChina
| | - Yanju Jia
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Hongyan Cui
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
| | - Xu Chen
- School of Medicine, Nankai UniversityTianjinChina
- Tianjin Key Laboratory of Human Development and Reproductive RegulationTianjinChina
- Tianjin Central Hospital of Obstetrics and GynecologyTianjinChina
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Powell J, Crowley CM, Minihan B, Imcha M, O’Connell NH, Philip RK, Dunne CP. The microbial pathology of maternal perinatal sepsis: A single-institution retrospective five-year review. PLoS One 2023; 18:e0295210. [PMID: 38150416 PMCID: PMC10752550 DOI: 10.1371/journal.pone.0295210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Greater than half of in-hospital maternal deaths are caused by sepsis, a condition that occurs when infection exceeds local tissue containment and results in organ dysfunction. Determining the source of infection can be challenging. Microbiological cultures of the uterine cavity are often difficult to obtain, so antimicrobial susceptibility results may not be available to guide treatment. The aim of this retrospective study was to assess the potential clinical value of microbiology samples used in the maternal "septic screen" of patients in an Irish maternity hospital. METHODS A review was completed of all maternal "septic screen" (i.e., high vaginal swabs, placenta swabs, blood cultures, throat swabs and urine samples) microbiology results from July 2016 to December 2021. RESULTS In the relevant period, 845 patients were subject to a "septic screen", of whom 430 also had a placental swab collected. These 430 patients comprise our study population. 2% of blood cultures yielded potential pathogens, compared with 37%, 33%, 9% and 7% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. 95% of blood cultures were sterile, compared with 52%, 0%, 0% and 53% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. CONCLUSION Of the five microbiological specimen types examined, placental swabs yielded the highest number of potential pathogens. Our results suggest that placental swabs are useful specimens for detecting potential pathogens from the uterine cavity, the most common source of perinatal infections.
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Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Clare M. Crowley
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Brid Minihan
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Mendinaro Imcha
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Nuala H. O’Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Roy K. Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
- University of Limerick School of Medicine, Limerick, Ireland
| | - Colum P. Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
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10
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Levy BE, Wilt WS, Castle JT, McAtee E, Walling SC, Davenport DL, Bhakta A, Patel JA. Surgical Site Infections in Colorectal Resections: What is the Cost? J Surg Res 2023; 283:336-343. [PMID: 36427443 DOI: 10.1016/j.jss.2022.10.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/26/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although surgical site infections (SSIs) associated with colectomy are tracked by the National Healthcare Safety Network/Center for Disease Control, untracked codes, mainly related to patients undergoing proctectomy, are not. These untracked codes are performed less often yet they may be at a greater risk of SSI due to their greater complexity. Determining the impact and predictors of SSI are critical in the development of quality improvement initiatives. METHODS Following an institutional review board approval, National Surgery Quality Improvement Program, institutional National Surgery Quality Improvement Program, and financial databases were queried for tracked colorectal resections and untracked colorectal resections (UCR). National data were obtained for January 2019-December 2019, and local procedures were identified between January 2013 and December 2019. Data were analyzed for preoperative SSI predictors, operative characteristics, outcomes, and 30-day postdischarge costs (30dPDC). RESULTS Nationally, 71,705 colorectal resections were identified, and institutionally, 2233 patients were identified. UCR accounted for 7.9% nationally and 11.8% of all colorectal resections institutionally. Tracked colorectal resection patients had a higher incidence of SSI predictors including sepsis, hypoalbuminemia, coagulopathy, hypertension, and American Society of Anesthesiologists class. UCR patients had a higher rate of SSIs [12.9% (P < 0.001), 15.2% (P = 0.064)], readmission, and unplanned return to the operating room. Index hospitalization and 30dPDC were significantly higher in patients experiencing an SSI. CONCLUSIONS SSI was associated with nearly a two-fold increase in index hospitalization costs and six-fold in 30dPDC. These data suggest opportunities to improve hospitalization costs and outcomes for patients undergoing UCR through protocols for SSI reduction and preventing readmissions.
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Affiliation(s)
- Brittany E Levy
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.
| | - Wesley S Wilt
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jennifer T Castle
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin McAtee
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Samuel C Walling
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel L Davenport
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Avinash Bhakta
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jitesh A Patel
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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11
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Shi M, Chen L, Ma X, Wu B. The risk factors and nursing countermeasures of sepsis after cesarean section: a retrospective analysis. BMC Pregnancy Childbirth 2022; 22:696. [PMID: 36085040 PMCID: PMC9461153 DOI: 10.1186/s12884-022-04982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Sepsis is a very serious complication of cesarean section, understanding the influencing factors is important to the prevention and management of sepsis. We aimed to analyze the associated risk factors of sepsis of cesarean section, to provide evidences into the clinical management and nursing care of cesarean section. Methods Patients who underwent cesarean section surgery from January 1, 2017 to June 30, 2021 in our hospital were included. The characteristics of patients were collected and analyzed. Logistic regression analyses were conducted to analyze the influencing factors of sepsis of cesarean section. Results A total of 3819 patients undergoing cesarean section were included, the incidence of sepsis in patients undergoing cesarean section was 0.84%. There were significant differences in the age, vaginal delivery attempt, premature rupture of membranes, preoperative hemoglobin, estimated blood loss during surgery and postoperative urinary tube implacement between sepsis and no sepsis patients (all p < 0.05). Logistic regression analyses found that age ≥ 35y(OR3.22, 95%CI1.20 ~ 5.15), gestational diabetes(OR2.64, 95%CI1.91 ~ 4.15), vaginal delivery attempt(OR2.05, 95%CI1.70 ~ 4.42), premature rupture of membranes(OR2.42, 95%CI1.02 ~ 4.20), preoperative hemoglobin ≤ 105 g/L(OR4.39, 95%CI1.02 ~ 7.88), estimated blood loss during surgery ≥ 400 ml(OR1.81, 95%CI1.35 ~ 3.01), postoperative urinary tube implacement(OR2.19, 95%CI1.27 ~ 2.50) were the risk factors of sepsis in patients undergoing cesarean section(all p < 0.05). Escherichia Coli(46.15%), Enterococcus faecalis(17.95%) and Pseudomonas aeruginosa(12.83%) were the most commonly-seen bacteria in sepsis patients. Conclusion In clinical practice, medical workers should carry out strict management and early prevention of related risk factors during the perioperative period of pregnant women, to effectively reduce the occurrence of sepsis after cesarean section.
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12
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Karaca SY, Adıyeke M, İleri A, İleri H, Vural T, Özmüş DN, Şimşek E, Özeren M. Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers. J Pediatr Adolesc Gynecol 2022; 35:472-477. [PMID: 35031447 DOI: 10.1016/j.jpag.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. DESIGN Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). RESULTS SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR = 2.35; 95% CI, 1.3-4.78), induction of labor (OR = 1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10 g/dl (OR = 2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. CONCLUSIONS BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.
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Affiliation(s)
- Suna Yıldırım Karaca
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Stem Cell, Izmir, Turkey
| | - Mehmet Adıyeke
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Alper İleri
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Hande İleri
- Alsancak State Hospital, Department of Family Medicine, Izmir, Turkey.
| | - Tayfun Vural
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Doğay Nurtaç Özmüş
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Ecem Şimşek
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Mehmet Özeren
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
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13
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Association of an Obstetric Surgical Closing Protocol With Infection After Cesarean Delivery. Obstet Gynecol 2022; 139:749-755. [DOI: 10.1097/aog.0000000000004729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
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14
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Salman SG, Rafiq M. Effect of vaginal scrubbing on post-C-section infection. HAMDAN MEDICAL JOURNAL 2022. [DOI: 10.4103/hmj.hmj_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Bizuayew H, Abebe H, Mullu G, Bewuket L, Tsega D, Alemye T. Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals, Amhara region, North West Ethiopia, 2020. PLoS One 2021; 16:e0261951. [PMID: 34972176 PMCID: PMC8719744 DOI: 10.1371/journal.pone.0261951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Maternal surgical site infection after cesarean delivery is a clinical problem which contributes to significant morbidity and mortality. In Ethiopia admissions following cesarean section due to surgical site infection have been routine activities of health care institutions but there is limited scientific evidence on both the magnitude of the problem and factors associated with it making prevention mechanisms less effective. Therefore, this study aimed to assess magnitude and risk factors of post-cesarean section surgical site infection at primary hospitals of East Gojjam Zone, Northwest Ethiopia. METHODS Institution-based cross sectional study with retrospective chart review was conducted from September 10-30 /2020 at 3 randomly selected primary hospitals of east Gojjam zone. The data were entered in Epi data version 3.1 and exported to Statistical Package for Social Science Software version 26. Post-cesarean section surgical site infection was measured based on disease classification and definition of the term by Center for Disease Control and Prevention. After checking for presence of multicollinarity, presence and degree of association of factors with outcome variable were computed through logistic regression analysis. Factors with P value ≤ 0.2 in bi-variable logistic regression analysis were included in the multivariable logistic regression analysis and those variables with P-value of <0.05 in multivariable analysis were considered statistically significant. RESULT From 622 medical records of women who underwent cesarean section, 77 (12.4%) of them developed surgical site infection. Rural residence [(AOR = 2.30, 95%CI: (1.29, 4.09)], duration of labor greater than 24hrs [(AOR = 3.48, 95%CI: (1.49, 8.09)], rupture of membrane>12hrs[(AOR = 4.61,95%CI:(2.34,9.09)], hypertension[(AOR = 3.14,95%CI:(1.29,7.59)] and preoperative Hematocrit ≤30%[(AOR = 3.22,95%CI:(1.25,8.31)] were factors significantly associated with post-cesarean section surgical site infections. CONCLUSION Magnitude of post-cesarean section surgical site infection was a significant problem in primary hospitals. Minimizing prolonged labor; minimize early rupture of membrane, properly managing patients with comorbidities like hypertension, strengthen prophylaxis and treatment for anemia during antenatal care and raising awareness for rural residents can reduce the problem. Zonal police makers should give emphasis to reduce its burden.
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Affiliation(s)
- Hulubante Bizuayew
- Department of Midwifery, Mizan Aman Health Science College, Mizan, Ethiopia
| | - Haimanot Abebe
- Department of Nursing, Wolkite University, Wolkite, Ethiopia
| | - Getachew Mullu
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Likinaw Bewuket
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Tsega
- Department of Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Tsegaw Alemye
- Department of Midwifery, Mizan Aman Health Science College, Mizan, Ethiopia
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16
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Risk factors for surgical site infection after cesarean delivery in a rural area in China: A case-controlled study. Ann Med Surg (Lond) 2021; 72:103110. [PMID: 34876985 PMCID: PMC8633558 DOI: 10.1016/j.amsu.2021.103110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background We aimed to determine the prevalence and risk factors of surgical site infection (SSI) after cesarean delivery (CD) in a rural area in China. Methods We identified 155 patients with incisional and organ/space SSIs by International Classification of Disease codes and matched them with 465 patients (controls) in a time-matched retrospective quality assurance analysis. Multiple logistic regression analyses were performed to examine the risk factors for SSI: the work-years of providers, the number of antenatal care (ANC) visits, CD after labor, positive discharge culture, postoperative C-reactive protein (CRP) levels and fever. Results and discussion: During the study, 155 women with SSI were identified among the 8640 patients who delivered by CD. The incidence of SSIs was 179 per 10 000patients (95%CI: 151–207 per 10 000 patients). The total duration of hospitalization in patients with SSI was 14.49 ± 8.68 days compared with 7.96 ± 2.35 days in patients with no SSI (P < 0.01). Multiple logistic regression analysis showed that the work-years of providers (odds ratio [OR] = 3.729, 95% confidence interval [CI]: 1.463–9.501, p = 0.006), irregular ANC visits (OR = 3.245, 95% CI: 1.264–8.329, p = 0.028), CD after labor (OR = 2.545, 95% CI: 0.935–6.926, p = 0.020), postoperative CRP level (OR = 2.545, 95% CI: 0.935–6.926, p = 0.016) and a positive discharge culture (OR = 2.954, 95% CI: 0.305–28.643, p = 0.019) were positively associated with SSI. However, the rates of maternal request (OR = 0.186, 95% CI: 0.065–0.535, p = 0.002) and postoperative fever (OR = 0.208, 95% CI: 0.087–0.494, p = 0.001) were negatively related to SSI. Conclusions Special attentions should be paid to CD patients who had irregular ANC visits, attempted labor, a positive discharge culture, higher CRP levels and fever after surgery, who had a greater risk of SSI. The incidence of SSIs was 179 per 10 000 patients (95%CI: 151–207). Risk factors of SSIs included: irregular ANC visits, a positive discharge culture. Higher CRP levels and fever after surgery had a greater risk of SSI.
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Dural İE, Gökaslan S, Yalım Z, Aksu U, Yılmaz ÖF, Ersoy İ, Sevil FC. Postpartum infective endocarditis with Enterococcus faecalis after vaginal delivery. Anatol J Cardiol 2021; 25:920-921. [PMID: 34866587 DOI: 10.5152/anatoljcardiol.2021.29797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- İbrahim Etem Dural
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - Serkan Gökaslan
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - Zafer Yalım
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - Uğur Aksu
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - Ömer Faruk Yılmaz
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - İbrahim Ersoy
- Department of Cardiology, Afyon Health Sciences University, Afyonkarahisar, Turkey
| | - Fehim Can Sevil
- Department of Cardiovascular Surgery, Afyon Health Sciences University, Afyonkarahisar, Turkey
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18
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Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, Thalib L, Andersson AE, Griffin B, Ware R, Chaboyer W. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. Int J Surg 2021; 95:106136. [PMID: 34655800 DOI: 10.1016/j.ijsu.2021.106136] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Establishing worldwide incidence of general surgical site infections (SSI) is imperative to understand the extent of the condition to assist decision-makers to improve the planning and delivery of surgical care. This systematic review and meta-analysis aimed to estimate the worldwide incidence of SSI and identify associated factors in adult general surgical patients. MATERIALS AND METHODS A systematic review was undertaken using MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library to identify cross-sectional, cohort and observational studies reporting SSI incidence or prevalence. Studies of less than 50 participants were excluded. Data extraction and quality appraisal were undertaken independently by two review authors. The primary outcome was cumulative incidence of SSI occurring up to 30 days postoperative. The secondary outcome was the severity/depth of SSI. The I2 statistic was used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Subgroup, meta-regression sensitivity analyses were used to explore the sources of heterogeneity. Publication bias was assessed using Hunter's plots and Egger's regression test. RESULTS Of 2091 publications retrieved, 62 studies were included. Of these, 57 were included in the meta-analysis across six anatomical locations with 488,594 patients. The pooled 30-day cumulative incidence of SSI was 11% (95% CI 10%-13%). No prevalence data were identified. SSI rates varied across anatomical location, surgical approach, and priority (i.e., planned, emergency). Multivariable meta-regression showed SSI is significantly associated with duration of surgery (estimate 1.01, 95% CI 1.00-1.02, P = .014). CONCLUSIONS and Relevance: 11 out of 100 general surgical patients are likely to develop an infection 30 days after surgery. Given the imperative to reduce the burden of harm caused by SSI, high-quality studies are warranted to better understand the patient and related risk factors associated with SSI.
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Affiliation(s)
- Brigid M Gillespie
- Griffith University Menzies Health Institute Queensland, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Australia Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Australia Griffith University Menzies Health Institute Queensland, Australia Gold Coast Hospital and Health Service, Department of Surgery, Australia Griffith University Faculty of Health, School of Nursing and Midwifery, Australia Princess Alexandra Hospital, Division of Surgery, QLD, Australia Gold Coast University Hospital, Patient Safety in Nursing, QLD, Australia Istanbul Aydın University, Department of Biostatistics, Faculty of Medicine, Istanbul, Turkey Sahlgrenska Academy, Institute of Health Care Sciences, Sweden Sahlgrenska University Hospital, Department of Orthopaedics, Sweden
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Chaboyer W, Ellwood D, Thalib L, Kumar S, Mahomed K, Kang E, Gillespie BM. Incidence and predictors of surgical site infection in women who are obese and give birth by elective caesarean section: A secondary analysis. Aust N Z J Obstet Gynaecol 2021; 62:234-240. [PMID: 34506037 DOI: 10.1111/ajo.13428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves. AIMS The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS. MATERIALS AND METHODS The method used was planned secondary analysis of data from women with a pre-pregnancy body mass index (BMI) ≥30 kg/m2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed-incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self-reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for four weeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI. RESULTS SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable-adjusted odds ratios (OR) for SSI were BMI ≥40 kg/m2 (OR 1.55, 95% confidence interval (CI) 1.30-1.86) as compared to BMI 30-34.9 0 kg/m2 , ≥2 previous pregnancies (OR 1.38, 95% CI 1.00-1.80) as compared to no previous pregnancies and pre-CS vaginal cleansing (OR 0.55, 95% CI 0.33-0.99). CONCLUSIONS Our findings may inform preoperative counselling and shared decision-making regarding planned elective CS for women with pre-pregnancy BMI ≥30 kg/m2 .
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Ellwood
- School of Medicine, Griffith University, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sailesh Kumar
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Kassam Mahomed
- Department of Obstetrics and Gynaecology and Faculty of Medicine, University of Queensland, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Evelyn Kang
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care and Menzies Health Institute Queensland & Gold Coast University Hospital, Griffith University, Gold Coast, Queensland, Australia
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20
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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; 21:248. [PMID: 34011324 PMCID: PMC8132410 DOI: 10.1186/s12893-021-01154-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background Surgical site infections after cesarean section are very common clinically, it is necessary to evaluate the risk factors of surgical site infections after cesarean section, to provide evidences for the treatment and nursing care of cesarean section. Methods This study was a retrospective cohort study design. Patients undergone cesarean section in a tertiary hospital of China from May 2017 to May 2020 were identified, we collected the clinical data of the included patients, and we analyzed the infection rate, etiological characteristics and related risk factors of surgical site infection after caesarean section. Results A total of 206 patients with cesarean section were included, and the incidence of surgical site infection in patients with cesarean section was 23.30%. A total of 62 cases of pathogens were identified, Enterococcus faecalis (33.87%) and Escherichia coli (29.03%) were the most common pathogens. Both Enterococcus faecalis and Escherichia coli were highly sensitive to Cefoperazone, Meropenem, and Levofloxacin. Logistic regression analyses indicated that Age ≥ 30y (OR 4.18, 95%CI: 1.23–7.09), BMI ≥ 24 (OR 2.39, 95%CI: 1.02–4.55), duration of cesarean section ≥ 1.5 h (OR 3.90, 95%CI: 1.28–5.42), estimated blood loss ≥ 400 ml (OR 2.35, 95%CI: 1.10–4.37) and the duration of urinary catheter ≥ 24 h (OR 3.18, 95% CI: 1.21–5.71) were the independent risk factors of surgical site infection after cesarean section (all p < 0.05). Conclusions Age, BMI, duration of surgery, blood loss and urinary catheter use were associated with higher risk of the surgical site infection after cesarean section. Clinical preventions and interventions are warranted for those population to reduce the occurrence of surgical site infection.
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Affiliation(s)
- Lijun Li
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai three Road, Nankai District, Tianjin, China
| | - Hongyan Cui
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai three Road, Nankai District, Tianjin, China.
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Gillespie BM, Webster J, Ellwood D, Thalib L, Whitty JA, Mahomed K, Clifton V, Kumar S, Wagner A, Kang E, Chaboyer W. Closed incision negative pressure wound therapy versus standard dressings in obese women undergoing caesarean section: multicentre parallel group randomised controlled trial. BMJ 2021; 373:n893. [PMID: 33952438 PMCID: PMC8097312 DOI: 10.1136/bmj.n893] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the effectiveness of closed incision negative pressure wound therapy (NPWT) compared with standard dressings in preventing surgical site infection (SSI) in obese women undergoing caesarean section. DESIGN Multicentre, pragmatic, randomised, controlled, parallel group, superiority trial. SETTING Four Australian tertiary hospitals between October 2015 and November 2019. PARTICIPANTS Eligible women had a pre-pregnancy body mass index of 30 or greater and gave birth by elective or semi-urgent caesarean section. INTERVENTION 2035 consenting women were randomised before the caesarean procedure to closed incision NPWT (n=1017) or standard dressing (n=1018). Allocation was concealed until skin closure. MAIN OUTCOME MEASURES The primary outcome was cumulative incidence of SSI. Secondary outcomes included depth of SSI (superficial, deep, or organ/body space), rates of wound complications (dehiscence, haematoma, seroma, bleeding, bruising), length of stay in hospital, and rates of dressing related adverse events. Women and clinicians were not masked, but the outcome assessors and statistician were blinded to treatment allocation. The pre-specified primary intention to treat analysis was based on a conservative assumption of no SSI for a minority of women (n=28) with missing outcome data. Post hoc sensitivity analyses included best case analysis and complete case analysis. RESULTS In the primary intention to treat analysis, SSI occurred in 75 (7.4%) women treated with closed incision NPWT and in 99 (9.7%) women with a standard dressing (risk ratio 0.76, 95% confidence interval 0.57 to 1.01; P=0.06). Post hoc sensitivity analyses to explore the effect of missing data found the same direction of effect (closed incision NPWT reducing SSI), with statistical significance. Blistering occurred in 40/996 (4.0%) women who received closed incision NPWT and in 23/983 (2.3%) who received the standard dressing (risk ratio 1.72, 1.04 to 2.85; P=0.03). CONCLUSION Prophylactic closed incision NPWT for obese women after caesarean section resulted in a 24% reduction in the risk of SSI (3% reduction in absolute risk) compared with standard dressings. This difference was close to statistical significance, but it likely underestimates the effectiveness of closed incision NPWT in this population. The results of the conservative primary analysis, multivariable adjusted model, and post hoc sensitivity analysis need to be considered alongside the growing body of evidence of the benefit of closed incision NPWT and given the number of obese women undergoing caesarean section globally. The decision to use closed incision NPWT must also be weighed against the increases in skin blistering and economic considerations and should be based on shared decision making with patients. TRIAL REGISTRATION ANZCTR identifier 12615000286549.
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Affiliation(s)
- Brigid M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
- Gold Coast University Hospital, Gold Coast Health, Southport, Qld, Australia
| | - Joan Webster
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - David Ellwood
- Gold Coast University Hospital, Gold Coast Health, Southport, Qld, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia
| | - Lukman Thalib
- School of Nursing and Midwifery, Griffith University, Gold Coast, Qld, Australia
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Norwich, UK
| | - Kassam Mahomed
- Ipswich Hospital, West Moreton Health, Ipswich, Qld, Australia
| | - Vicki Clifton
- Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
- Mater Mothers' Hospital, South Brisbane, Qld, Australia
| | - Adam Wagner
- Norwich Medical School, University of East Anglia, Norwich, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Norwich, UK
| | - Evelyn Kang
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
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22
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Cabral BG, Brasiliense DM, Furlaneto IP, Rodrigues YC, Lima KVB. Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region. Microorganisms 2021; 9:microorganisms9040743. [PMID: 33918140 PMCID: PMC8067217 DOI: 10.3390/microorganisms9040743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.
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Affiliation(s)
- Blenda Gonçalves Cabral
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Danielle Murici Brasiliense
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
- Correspondence: ; Tel.: +55-9132-1421-16
| | | | - Yan Corrêa Rodrigues
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Karla Valéria Batista Lima
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
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23
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Romero Viamonte K, Salvent Tames A, Sepúlveda Correa R, Rojo Manteca MV, Martín-Suárez A. Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital. Antimicrob Resist Infect Control 2021; 10:12. [PMID: 33436096 PMCID: PMC7805169 DOI: 10.1186/s13756-020-00843-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. METHODS A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. RESULTS The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. CONCLUSIONS Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.
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Affiliation(s)
- Katherine Romero Viamonte
- Faculty of Health Sciences, Technical University of Ambato, Ambato, Ecuador
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
| | | | | | - María Victoria Rojo Manteca
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
- Provincial Pharmacists Chamber, Ávila, Spain
| | - Ana Martín-Suárez
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
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24
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Wang CN, Foo J, Huang IT, Fan YC, Tsai PS, Huang CJ. Identifying more risk factors for surgical site infection following cesarean section. Eur J Obstet Gynecol Reprod Biol 2020; 251:282-284. [PMID: 32505513 DOI: 10.1016/j.ejogrb.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Chao-Nin Wang
- Department of Obstetrics & Gynaecology, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan.
| | - Jossen Foo
- Department of Anaesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan; Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan.
| | - I-Tao Huang
- Department of Emergency Medicine, Redcliffe Hospital, Metro North Hospital and Health Service, Queensland Government, Anzac Avenue, Redcliffe, QLD 4020, Australia; School of Public Health, Faculty of Medicine, University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia.
| | - Yen-Chun Fan
- Department of Anaesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan; Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan.
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, 250, Wu-Hsing St., Taipei 110, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan; Research Centre of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan.
| | - Chun-Jen Huang
- Department of Anaesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan; Integrative Research Centre for Critical Care, Wan Fang Hospital, Taipei Medical University, 111, Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 116, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250, Wu-Hsing St., Taipei 110, Taiwan.
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