Surgical Site Infection after Caesarean Section: Epidemiology, Microbiology, Management and Prevention in a Tertiary Health Facility in Niger Delta Region, Nigeria

Background: Surgical site infection despite marked advances in surgical techniques and preventive measures continues to contribute substantially to hospital morbidity, financial burden and mortality.

Aims: This study was designed to measure surgical site infection rate following caesarean section, investigate the risk factors and the pattern of the offending microbes. The paucity of SSI data from authors’ center influenced the desire to contribute data to cesarean section-related SSI.

Study Design: A case control study.

Place and Duration of Study: Niger Delta University Teaching Hospital Bayelsa State Nigeria between May 2018 and March 2020.

Methodology: Consenting cases of caesarean procedure-related surgical site infection were recruited as study group and the next non-infected caesarean patients as the control group. Descriptive statistics was done with EPI Info and Instat software. Relative risk (RR) determined association of variables and SSI with p-value <.05.

Results: Twenty six (9.4%) of the 276 caesarean section cases had surgical site infection. Unbooked status (RR 2.4, p=0.003), BMI≥30mgm-2(RR 2.2, p=0.02), surgery duration > 60 minutes (RR 5.3, p=0.03), interrupted stitch (RR 3.0, P<0.001), prolonged rupture of fetal membranes (p=0.008), chorioamnionitis (RR2.68, p=0.002), estimated blood loss>1000ml (p=0.02) were significant risk factors for SSI. SSIs had longer postoperative hospital stay median (IQR) 14.5(10-21) vs.6.0 (5-7), P<.001. Obstructed labor (42.3%) was responsible for most of SSIs after C-section. Wound discharge (37%), fever (23%) and wound dehiscence 17% were the main clinical features of SSI. The most isolated microorganisms were staphylococcus aureus (22.7%), klebsiella species and Escherichia coli 18.2% each and they were predominantly susceptible to quinolones and gentamicin and resistant to beta-lactam antibiotics.

Conclusions: Surgical site infection after C-section is still common in Nigeria. The factors were multifactorial and largely modifiable.