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Lwigale F, Kibombo D, Kasango SD, Tabajjwa D, Atuheire C, Kungu J, Kalule JB, Otita M, Kakooza F, Nabukenya I, Mayito J, Rwego IB. Prevalence, resistance profiles and factors associated with skin and soft-tissue infections at Jinja regional referral hospital: A retrospective study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003582. [PMID: 39093883 PMCID: PMC11296629 DOI: 10.1371/journal.pgph.0003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
Skin and soft-tissue infections (SSTI) are common cases of hospital-acquired infections with aetiological agents exhibiting antimicrobial resistance (AMR). This is a global public health predicament responsible for a high burden of infectious diseases and threatens the achievement of Sustainable Development Goals (SDGs), especially in Low- and Middle-Income countries (LMICs). This study determined the prevalence of SSTI, proportion of laboratory-investigated cases, AMR-profiles, and factors associated with SSTI and multi-drug resistance (MDR). This was based on records of patients suspected of SSTI for the period of 2019-2021 at Jinja Regional Referral Hospital. The analysis involved 268 randomly selected patient reports using WHONET 2022 and Stata 17 at the 95% confidence level. The prevalence of SSTI was 66.4%. Cases that involved laboratory testing were 14.1%. Staphylococcus aureus (n = 51) was the most isolated organism. MDR pathogens explained 47% of infections. Methicillin-resistant Staphylococcus aureus (MRSA) was up to 44%. In addition, 61% of Gram-negatives had the potential to produce extended-spectrum beta-lactamases (ESBL), while 27% were non-susceptible to carbapenems. Ward of admission was significantly associated with infection (aPR = 1.78, 95% CI: 1.00-3.18, p-value = 0.04). Age category (19-35) was an independent predictor for MDR infections (aPR = 2.30, 95%CI:1.02-5.23, p-value = 0.04). The prevalence of SSTI is high with MDR pathogens responsible for almost half of the infections. Gentamicin and ciprofloxacin can be considered for empirical management of strictly emergency SSTI cases suspected of Staphylococcus aureus. Given the high resistance observed, laboratory-based diagnosis should be increased to use the most appropriate treatment. Infection Prevention and Control (IPC) strategies should be heightened to reduce the prevalence of SSTI. Recognizing SSTI under the Global Antimicrobial resistance Surveillance System (GLASS) would lead to improved preparedness and response to AMR.
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Affiliation(s)
- Fahad Lwigale
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Daniel Kibombo
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon Dembe Kasango
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Uganda National Health Research Organization, Ministry of Health, Kampala, Uganda
| | - Dickson Tabajjwa
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Collins Atuheire
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Joseph Kungu
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - John Bosco Kalule
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Morgan Otita
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Kakooza
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Immaculate Nabukenya
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Jonathan Mayito
- Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Innocent B. Rwego
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
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Monari C, Onorato L, Coppola N, Raviglione MCB, Gon G. Burden of Antimicrobial Resistance Among Women with Post-Partum Infections in Low-Middle Income Countries: A Systematic Review. J Epidemiol Glob Health 2024; 14:274-290. [PMID: 38630391 PMCID: PMC11176113 DOI: 10.1007/s44197-024-00222-8] [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: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Due to the rising incidence of multidrug-resistant (MDR) pathogens, especially in Low-Middle-Income Countries (LMIC), post-partum infections represent a significant treatment challenge. METHODS We performed a systematic review of the literature from January 2005 to February 2023 to quantify the frequency of maternal post-partum infections due to MDR pathogens in LMICs, focusing on methicillin-resistant Staphylococcus aureus (MRSA) and/or extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales. SECONDARY OBJECTIVES description of antimicrobials' prescriptions. FINDINGS We included 22 studies with 14,804 total bacterial isolates from 12 countries, mostly from WHO African-Region. Twelve papers described wound- and 10 puerperal-infections. Seven were high-quality articles. Seventeen studies reported data on MRSA, and 18 on ESBL-producing Enterobacterales. Among high-quality studies, MRSA ranged from 9.8% in Ghana to 91.2% in Uganda; ESBL-producing Enterobacterales ranged from 22.8% in Ukraine to 95.2% in Uganda. Nine articles, mostly on C-sections, described different protocols for antibiotic prophylaxis and/or post-partum treatment. INTERPRETATION We described a high burden of post-partum infections caused by MRSA and/or ESBL-producing Enterobacterales in LMICs, but only a few studies met quality standards. There is an urgent need for high-quality studies to better describe the real burden of antimicrobial resistance in low-resource settings and inform policies to contain the spread of multidrug-resistant organisms.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, AOU Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Nicola Coppola
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
| | | | - Giorgia Gon
- Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, London, UK
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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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Boutefnouchet C, Aouras H, Khennouchi NCEH, Berredjem H, Rolain JM, Hadjadj L. Algerian postcaesarean surgical site infections: A cross-sectional investigation of the epidemiology, bacteriology, and antibiotic resistance profile. Am J Infect Control 2024; 52:456-462. [PMID: 37805027 DOI: 10.1016/j.ajic.2023.09.022] [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: 07/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are one of the most common health care-associated infections in low and middle-income countries. The aims of this cross-sectional descriptive study were to estimate the frequency of postcaesarean infection with associated clinical characteristics and the antibiotic resistance profile of bacterial isolates. METHODS Patients who underwent a cesarean section at the obstetrics and gynecology department of the hospital in Annaba, Algeria were included. Each woman was followed postoperatively for 30 days and sociodemographic data were collected. Culture-based microbiological methods were used to identify the causative bacteria and determine their antibiotic resistance phenotype and molecular characterization. RESULTS Among 1,810 patients, we recorded 36 (1.9%) SSIs. Most patients had undergone an emergency delivery (75%) and low educational level (72.2%). The most frequent maternal pathologies were Body Mass Index ≥ 30 (63.9%), scarred uteri (58.3%), anemia (55.6%), and an American Society of Anaesthesiologists score between II and III (33.3%). Of the 43 bacteria isolated, Enterobacteriaceae were the most frequent (62.8%), predominated by Escherichia coli strains (43.5%), a majority of which were extended-spectrum β-lactamases carriers (62.9%). Although gram-positive cocci were less frequent (37.2%), a majority of Enterococcus faecalis (56.2%) were observed and 2 strains of vancomycin-resistant Enterococcus faecium harboring the vanA gene were identified. CONCLUSIONS Extensive surveillance of at-risk populations should be integrated to prevent the occurrence of SSIs.
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Affiliation(s)
- Chahinez Boutefnouchet
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria; Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Hayet Aouras
- Etablissement Hospitalier de Santé Abdallah Nouaouria "'El Bouni"' Annaba, Algeria
| | - Nour Chems El Houda Khennouchi
- Laboratoire de Biotechnologie des substances naturelles et applications, Université L'arbi Ben M'hidi, Oum El Bouaghi, Algeria
| | - Hajira Berredjem
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria
| | - Jean-Marc Rolain
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Linda Hadjadj
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France.
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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 2024; 6:100333. [PMID: 38222856 PMCID: PMC10787233 DOI: 10.1016/j.infpip.2023.100333] [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: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Background Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya. Methods This was a retrospective case-control (1:2 matched) study conducted between 1st November 2021 to 31st October 2022 at a tertiary hospital in Nairobi. Data was extracted on surgical site risk factors as per World Health Organization's recommended preoperative measures, for both cases and controls. Descriptive statistics was used to summarize the variables and the Chi-squared test and Fisher's Exact test were used for group comparisons. Results A total of 1,262 caesarian deliveries were performed, 2.1% (27/1262) of which developed surgical site infections post caesarian section. The risk factors identified were not significantly associated with surgical site infection development (gestational age P=0.152, body mass index P=0.615, premature rupture of membranes P=0.253, and antibiotic prophylaxis P=0.108). Conclusions There was no significant association of exposure to surgical site infection risk factors with surgical site infection despite a positive trend. Other prospective methods should also be used in addition to chart reviews to determine the level of effect each risk factor has on surgical site infection.
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Affiliation(s)
- David Odada
- Department Nursing, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Annastacia Mbithi
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
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Abdelrahman MA, Zaki A, Salem SAM, Salem HF, Ibrahim ARN, Hassan A, Elgendy MO. The Impact of Cefepime and Ampicillin/Sulbactam on Preventing Post-Cesarean Surgical Site Infections, Randomized Controlled Trail. Antibiotics (Basel) 2023; 12:1666. [PMID: 38136700 PMCID: PMC10740998 DOI: 10.3390/antibiotics12121666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/09/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Over the previous three decades, the rate of caesarean sections performed worldwide has grown exponentially. In comparison to a vaginal birth, the risk of all postpartum infections is higher with a cesarean section. One of the key factors contributing to maternal morbidity is the development of infectious complications in the surgical site after a caesarean section. The primary goal of the research was to compare the efficiency of using ampicillin/sulbactam (AMS) and cefepime (CEF) to reduce the incidence of surgical site infections (SSI) following caesarean delivery. This prospective randomized study was conducted among 200 pregnant women scheduled for elective cesarean section. They were collected from the Obstetrics and Gynecology department of Beni-Suef University Hospital, and then they were randomly assigned into two groups. Group (A) received cefepime 30 min before and 12 h after cesarean delivery, while group (B) received ampicillin/sulbactam 30 min before and 12 h after cesarean delivery. The groups were matched regarding the baseline women characteristics. Comparing the cefepime to the ampicillin/sulbactam revealed that the cefepime significantly decreased superficial SSI from 27% to 14% (0.023). A significant decrease was observed in deep SSI with cefepime compared to ampicillin/sulbactam from 24% to 13% (p-value 0.045). Interestingly, when the cefepime was compared to the ampicillin/sulbactam, we noted that the incidence of endometritis significantly decreased from 13% to 5% (p = 0.048). A noted decrease in post-operative fever in cefepime as compared to ampicillin/sulbactam from 18% to 13% (p-value = 0.329). Receiving prophylactic cefepime pre- and post-cesarean delivery significantly decreases post-operative wound infection and endometritis.
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Affiliation(s)
- Mona A. Abdelrahman
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Asmaa Zaki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62764, Egypt; (A.Z.); (M.O.E.)
| | - Sara A. M. Salem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt;
| | - Heba F. Salem
- Department of Pharmaceutics & Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt;
- Department of Pharmaceutics and Industrial Pharmacy, 6 October Technological University, Giza 12585, Egypt
| | - Ahmed R. N. Ibrahim
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia;
| | - Ahmed Hassan
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City, Sadat City 32897, Egypt;
| | - Marwa O. Elgendy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62764, Egypt; (A.Z.); (M.O.E.)
- Department of Clinical Pharmacy, Beni-Suef University Hospitals, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt
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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. [PMID: 37854040 PMCID: PMC10581010 DOI: 10.2147/ijwh.s425632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
Background Surgical site infections (SSI) after cesarean section are common in Ethiopia and result in maternal morbidity, mortality, hospitalization, and medical costs. This study aimed to determine the incidence, bacterial profile, and associated factors of surgical site infection after cesarean section (CS) in public and private referral hospitals. Methods A prospective observational cohort study was conducted on 741 pregnant women who underwent CS from July to September 2022. Women who had CS were followed up for at least 30 days. Infected wound specimens from those who had SSIs were collected and bacteriologically analyzed. The data were analyzed with SPSS version 25. The logistic regression model assessed the relationship between the independent variable and the outcome with 95% confidence interval. Results The incidence of post-cesarean surgical site infection was 11.6% (95% Cl: 9.4, 13.6). Staphylococcus aureus was the most common bacteria in CS wounds 10 (21.2%). Two to three antenatal care visits (ANC) (AOR: 3.11, 95% CI: 1.69, 5.75), delayed antenatal booking (AOR: 6.99, 95% CI: 2.09, 23.32), membrane rupture (AOR: 2.10, 95% CI: 1.04, 4.24), multiple vaginal examinations (AOR = 4.21, 95% CI: 1.35, 6.92) and public hospitals (AOR: 11.1, 95% CI: 1.48, 45, 14) were associated with increased risk of SSI after CS, in contrary shorter hospital stays (AOR = 0.37, 95% CI: 0.15, 0.91) and transversal incisions (AOR = 0.38, 95% CI: 0.15, 0.91) were associated with lower risk SSI after CS. Conclusion The incidence of SSI after CS was high. Delayed antenatal booking, two to three antenatal visits, multiple vaginal exams, membrane rupture, vertical incision, longer postoperative hospital stays, and procedures in public hospitals were associated with increased risk of SSI after CS. Therefore, intervention programs should focus on post-discharge surveillance and identification of risk to reduce and prevent SSI after CS rate.
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Affiliation(s)
- Rahel Mezemir
- Pan African University, Life and Earth Sciences Institute (Including Health and Agriculture), Ibadan, Nigeria
- St. Paul’s Hospital Millennium Medical College, School of Nursing, Addis Ababa, Ethiopia
| | - Oladapo Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- College of Health and Medical Sciences Haramaya University, Harar, Ethiopia
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Gillespie BM, Ellwood D, Thalib L, Kumar S, Mahomed K, Kang E, Chaboyer W. Incidence and risk factors for surgical wound complications in women with body mass index >30 kg/m2 following cesarean delivery: a secondary analysis. AJOG GLOBAL REPORTS 2022; 2:100069. [PMID: 36276792 PMCID: PMC9563898 DOI: 10.1016/j.xagr.2022.100069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RESULTS CONCLUSION
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Hirani S, Trivedi NA, Chauhan J, Chauhan Y. A study of clinical and economic burden of surgical site infection in patients undergoing caesarian section at a tertiary care teaching hospital in India. PLoS One 2022; 17:e0269530. [PMID: 35658054 PMCID: PMC9165765 DOI: 10.1371/journal.pone.0269530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Caesarian section is one of the most commonly performed surgeries in India. Determination of the incidence as well as the clinical and financial burden of post caesarian surgical site infection (SSI), is of critical importance for all the stakeholders for rational and fair allocation of resources. Methods This study was a prospective observational case-control study. The mean direct and indirect cost of treatment for the cases were compared with the control patients. An unpaired t-test was used to compare the mean between the two groups. Results Out of 2024 patients, who underwent caesarian section during the study period, 114 had acquired incisional surgical site infection (ISSI), with the infection incidence being 5.63%. The total cost of illness due to post caesarian ISSI was almost three times higher compared to the non-infected matched control group. (P<0.0001). An average length of hospital stay in the ISSI patient group was 10 days longer than that in the control group (P<0.0001) and importantly total length of antimicrobial therapy(LOT) in patients with ISSI was also almost three times higher than the control group (P<0.0001). Conclusion The development of post caesarian SSI imposes a significant clinical as well as a financial burden. The study highlights the necessity of taking effective preventive measures to decrease the incidence of SSI.
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Affiliation(s)
- Shilpa Hirani
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
| | - Niyati A. Trivedi
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
- * E-mail:
| | - Janki Chauhan
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
| | - Yash Chauhan
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
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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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Alfouzan W, Al-Balushi Z, Al-Maslamani M, Al-Rashed A, Al-Sabah S, Al-Salman J, Baguneid M, Khamis F, Habashy N, Kurdi A, Eckmann C. Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant <i>Staphylococcus aureus</i> in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.
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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; 21:634. [PMID: 34537018 PMCID: PMC8449867 DOI: 10.1186/s12884-021-04054-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3-20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. METHODS This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. RESULTS The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12-6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11-4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62-3.09), emergency CS (AOR 2.16; 95% CI =1.61-2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67-2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66-2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06-2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02-2.1 3), obesity (AOR 1.34; 95% CI =0.95-1.84), high parity (AOR 1.27; 95% CI = 1.03-1.88), hypertension (AOR 1.19; 95% CI = 0.92-2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94-1.66). The mortality rate due to SSI was 1.33%. CONCLUSIONS The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. REGISTRATION Local ethical committee (Registration number: MOBGYN0040).
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Affiliation(s)
- Khaled Gomaa
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed R Abdelraheim
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Saad El Gelany
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eissa M Khalifa
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman M Yousef
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan
- Minia Maternity and Children University Hospital, Obstetrics and Gynecology Department, Faculty of Medicine, Minia University, Minia, Egypt
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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:e0253194. [PMID: 34161361 PMCID: PMC8221476 DOI: 10.1371/journal.pone.0253194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cesarean section (CS) is often complicated by surgical site infection (SSI) that may happen to a woman within 30 days after the operation. This study was conducted to estimate the prevalence of SSI and identify the factors associated with SSI. Methods A hospital-based analytic cross-sectional study was conducted based on the review of medical records of 1069 women who underwent CS in two public hospitals in Harar city. The post-CS SSI is defined when it occurred within 30 days after the CS procedure. Factors associated with SSI were identified using a multivariable binary logistic regression analysis. The analysis outputs are presented using an adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI). All statistical tests are defined as statistically significant at P-values<0.05. Results The prevalence of SSI was 12.3% (95% confidence interval (CI): 10.4, 14.4). Emergency-CS was conducted for 75.9% (95% CI: 73.2, 78.3) of the women and 13.2% (95% CI: 11.3, 15.4) had at least one co-morbid condition. On presentation, 21.7% (95% CI: 19.3, 24.3) of women had rupture of membrane (ROM). Factors significantly and positively associated with post-CS SSI include general anesthesia (aOR = 2.0, 95%CI: 1.10, 2.90), ROM (aOR = 2.27, 95%CI: 1.02, 3.52), hospital stay for over 7 days after operation (aOR = 3.57, 95%CI: 1.91, 5.21), and blood transfusion (aOR = 4.2, 95%CI: 2.35, 6.08). Conclusion The prevalence of post-CS SSI was relatively high in the study settings. Screening for preoperative anemia and appropriate correction before surgery, selection of the type of anesthesia, close follow-up to avoid unnecessary prolonged hospitalization, and careful assessment of membrane status should be considered to avoid preventable SSI and maternal morbidity.
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Affiliation(s)
- Tsegaw Alemye
- Department of Midwifery, Mizan-Aman Health Sciences College, Mizan-Aman, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gelana Fekadu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melkamu Merid Mengesha
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
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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] [MESH Headings] [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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Tandon P, Lee EY, Maxwell C, Hitz L, Ambrosio L, Dieleman L, Halloran B, Kroeker K, Huang VM. Fecal Calprotectin May Predict Adverse Pregnancy-Related Outcomes in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:1639-1649. [PMID: 32533542 DOI: 10.1007/s10620-020-06381-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role of fecal calprotectin in predicting pregnancy-related outcomes in inflammatory bowel disease (IBD) remains unknown. AIM To determine whether increased fecal calprotectin during pregnancy is associated with adverse pregnancy outcomes in IBD. METHODS This is a multicenter cohort study of women with IBD who underwent fecal calprotectin monitoring during pregnancy. Fecal calprotectin levels were stratified by trimester, and adverse pregnancy-related outcomes were recorded. The Mann-Whitney U test assessed differences between continuous variables, whereas categorical variables were compared using the Chi-squared test. RESULTS Eighty-five women with IBD were included. First trimester fecal calprotectin was higher in patients who underwent emergency Cesarean birth compared to those who had a vaginal delivery (503 ug/g, IQR 1554.3 ug/g vs. 130 ug/g, IQR 482 ug/g, p = .030, respectively) and in those who delivered infants with low birth weight compared to normal birth weight (1511 ug/g, IQR 579 ug/g vs. 168 ug/g, IQR 413 ug/g, p = .049, respectively). Third trimester fecal calprotectin was higher in those with non-elective induction of labor (334.5 ug/g, IQR 1411.0 ug/g) compared to those with spontaneous delivery (116.5 ug/g, IQR 227.1 ug/g) (p = .025). Those with a fecal calprotectin ≥ 250 ug/g in the second trimester had an increased incidence of infants with low birth weight (35.3% vs. 3.8%) (p = .049), whereas those with a fecal calprotectin ≥ 250 ug/g in the third trimester had an increased incidence of non-elective induction of labor (43.8% vs. 10.3%, p = .030). CONCLUSIONS Fecal calprotectin may be a useful noninvasive marker to predict adverse pregnancy-related outcomes in patients with IBD.
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Affiliation(s)
- Parul Tandon
- Division of Gastroenterology, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada.,Department of Medicine, University of Toronto, 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Eugenia Y Lee
- Department of Medicine, University of Toronto, 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, 901-700 University Avenue, Toronto, ON, M5G 1Z5, Canada
| | - Lara Hitz
- Division of Gastroenterology, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Levinus Dieleman
- Division of Gastroenterology, University of Alberta, 2-24A Zeidler Building, Edmonton, AB, T6G 2X8, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, 130 University Campus NW, Edmonton, AB, T6G 2X8, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, 8540 112th Street NW, Edmonton, AB, T6G 2X8, Canada
| | - Vivian M Huang
- Division of Gastroenterology, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada. .,Department of Medicine, University of Toronto, 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Ayala D, Tolossa T, Markos J, Yilma MT. Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia. PLoS One 2021; 16:e0250736. [PMID: 33905428 PMCID: PMC8079023 DOI: 10.1371/journal.pone.0250736] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022] Open
Abstract
Background Surgical site infection (SSI) is a serious public health problem due to its impacts on maternal morbidity and mortality and it can have a significant effect on quality of life for the patient. However, little has been studied regarding the magnitude and factors associated with SSI among women underwent cesarean delivery (CD) in study area. Therefore, the aim of this study was to assess the magnitude and factors associated with SSI among women underwent cesarean delivery in Nekemte Town Public Hospitals 2020. Methods An institution based cross-sectional study was conducted from January 1/2018 to January 1/2020. A simple random sampling technique was employed to select 401 patient cards from all records women underwent CD from January 1/2018 to January 1/2020. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A logistic regression model was used to determine the association of independent variables with the outcome variable and adjusted odds ratios (AOR) with 95% confidence interval was used to estimate the strength of the association. Results Three hundred eight two (382) cards of women were selected for analysis making a response rate of 95.2%. The mean (±SD) age of the mothers was 25.9 (±4.8) years. The prevalence of SSIs was 8.9% (95% CI: 6.03, 11.76). Age > 35 years (AOR = 5.03, 95% CI:1.69, 14.95), pregnancy-induced hypertension (AOR = 5.63, 95%CI:1.88, 16.79), prolonged labor (AOR = 4.12, 95% CI:1.01, 32.19), receiving general anesthesia (AOR = 3.96 95% CI:1.02, 15.29), and post-operative hemoglobin less than 11 g/dl (AOR = 4.51 95% CI:1.84, 11.07) were significantly associated with the occurrence of SSI after cesarean delivery. Conclusions and recommendations The magnitude of post CD SSI in this study was comparable with the sphere standards of CDC guidelines for SSI after CD. Concerned bodies should give due attention the proper utilization of partograph to prevent prolonged labor, and provision of iron folate to increase the hemoglobin level of pregnant mothers in all health institution. In addition, we would recommend the use of spinal anesthesia over general anesthesia.
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Affiliation(s)
- Diriba Ayala
- Department of Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Jote Markos
- Department of Nursing, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
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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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Aghdassi SJS, Schröder C, Gastmeier P. Urgency of surgery as an indicator for the occurrence of surgical site infections: data from over 100,000 surgical procedures. J Hosp Infect 2021; 110:1-6. [PMID: 33422591 DOI: 10.1016/j.jhin.2020.12.017] [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: 09/03/2020] [Revised: 11/05/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The risk for surgical site infections (SSIs) is influenced by patient- and procedure-related factors. Urgent surgery represents a challenge in operative medicine and is frequently linked to a variety of complications, including SSIs. AIM We aimed to investigate whether urgency was significantly associated with SSI occurrence, and determine whether collection of this variable provided useful information for SSI surveillance. METHODS We performed a retrospective data analysis of caesarean sections (C-sections) and colon surgeries conducted between 2017 and 2019 within the German national SSI surveillance network. A multivariable logistic regression model was utilized to determine the influence of urgency on SSI occurrence. For this purpose, data on procedures and SSIs were associated with available department- and patient-related parameters. FINDINGS A total of 115,648 procedures were included in the analysis: 78,288 C-sections and 37,360 colon surgeries. For C-sections, the SSI rate per 100 procedures was 0.98 (95% confidence interval: 0.85-1.11) for urgent and 0.46 (0.40-0.53) for elective procedures (P<0.001). For open colon surgeries, SSI rates were 9.66 (8.89-10.49) for urgent and 8.60 (8.13-9.11) for elective procedures (P<0.001). For laparoscopic colon surgeries, SSI rates did not differ significantly. Multivariable analysis revealed that urgency significantly increased the likelihood of SSI occurrence only for C-sections. CONCLUSION Urgency significantly increased the SSI risk of C-sections, but not colon surgeries. Hence, collection of this variable is useful for SSI surveillance of C-sections, but may be dispensable for other procedures. Future analyses on the matter should therefore focus on other procedure types.
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Affiliation(s)
- S J S Aghdassi
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany.
| | - C Schröder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - P Gastmeier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
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Gupta S, Manchanda V, Sachdev P, Kumar Saini R, Joy M. Study of incidence and risk factors of surgical site infections in lower segment caesarean section cases of tertiary care hospital of north India. Indian J Med Microbiol 2020; 39:1-5. [PMID: 33610238 DOI: 10.1016/j.ijmmb.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the incidence density, risk factors and common pathogens associated with surgical site infections (SSI) following lower segment caesarean section (LSCS) surgeries. METHODS In this Non-interventional prospective observational study, a total of 611 post caesarean emergency and elective cases were enrolled among the 1018 LSCS cases conducted for the period of May-August 2016. The demographic, risk factors and clinical data for appearance of signs and symptoms of SSI were recorded in a preformatted proforma. SSI's were classified as superficial, deep and organ space as per Centre for Disease Control (CDC), USA definitions. Pus specimens were processed and antimicrobial susceptibility results of the organisms were determined as standard microbiological techniques. RESULTS The SSI rate was found to be 10.3 per 100 surgeries in our study with superficial SSI (66.7%) being most common. Inappropriate pre-surgical antibiotic prophylaxis, anaemia, previous LSCS as indication of LSCS, intra-operative blood transfusion and comorbid illness like heart disease, hypothyroidism, chronic liver and kidney disease were found to be significantly associated with SSI. Predominance of gram negative isolates (55.3%) was seen in comparison to gram positive isolates (44.7%) as cause of surgical site infections. CONCLUSIONS SSIs rates observed are much higher than those observed in NHSN participating hospitals. Many of the risk factors identified are low hanging fruits and can be targeted to effectively reduce SSI rates.
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Affiliation(s)
- Shilpi Gupta
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Vikas Manchanda
- Department of Microbiology Maulana Azad Medical College and Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Poonam Sachdev
- Department of Obstetrics and Gynecology Lok Nayak Hospital, New Delhi, 110002, India.
| | - Rajesh Kumar Saini
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
| | - Minimol Joy
- Infection Control Division, Lok Nayak Hospital, New Delhi 110002, India.
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Childs C, Soltani H. Abdominal Cutaneous Thermography and Perfusion Mapping after Caesarean Section: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8693. [PMID: 33238522 PMCID: PMC7700549 DOI: 10.3390/ijerph17228693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a 'surrogate' of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to 'interrogate' the abdominal thermal map. A specific thermal signature ('cold spots') was identified as an early 'flag' for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue 'at risk'. By identifying skin 'hot' or 'cold' spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.
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Affiliation(s)
- Charmaine Childs
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield S10 2BP, South Yorkshire, UK;
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Abstract
Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case–control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36–1.66), low education level (OR 1.68, 95% CI 1.55–1.84), previous CS (OR 1.27, 95% CI 1.10–1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18–1.88), a long decision–incision time (OR 2.08, 95% CI 1.74–2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10–2.85).
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22
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Risk factors for surgical site infections after open reduction and internal fixation of acetabulum fracture in the west of Iran. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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