Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study

Determinants of post-cesarean delivery surgical site infection in Mekelle public hospitals, Tigray, North Ethiopia, in 2024

BACKGROUND

Due to the increased frequency of cesarean deliveries, the number of women with surgical site infections (SSIs) is rising. Surgical site infections remain a concern in low-resource countries, despite the implementation of prevention and control measures, as they lead to extended hospital stays and significant additional costs for the patient. While studies on SSIs exist in the developing world and Africa, to the best of our knowledge, there is limited research specifically examining their determinants, particularly in Ethiopia.

OBJECTIVE

This study aimed to assess the determinants of SSI after cesarean delivery in Mekelle public hospitals, Northern Ethiopia.

METHODS

An institutional-based retrospective chart review case-control study was conducted from February 18, 2021, to March 14, 2021, using maternal records from July 8, 2018, to July 7, 2020. The required sample size was 237 (158 controls and 79 cases). Data were collected using a pretested and structured checklist with systematic sampling, then entered into EpiData 3.5.1 and analyzed using SPSS version 23. Binary logistic regression and multivariable logistic regression were used to determine the association of independent variables with the dependent variable. Variables with P-values <0.25 in bivariate logistic regression were exported to multivariable analysis, and variables with P-values <0.05 in multivariable analysis were considered significantly associated with the outcome variable.

RESULTS

The multivariable logistic regression revealed the significant determinants of post-cesarean delivery SSI were ruptured membranes before cesarean delivery (adjusted odds ratio [AOR] = 4.7, 95% confidence interval [CI] = 2.02, 10.91), prolonged operation time (AOR = 3.24, 95% CI = 1.19, 8.78), estimated blood loss greater than 500 mL (AOR = 4.7, 95% CI = 2.16, 10.40), and postoperation hemoglobin level of <11 g/dL (AOR = 4.2, 95% CI = 1.94, 9.20).

CONCLUSION

This study revealed that the determinants for developing post-cesarean delivery SSI were ruptured membranes before cesarean delivery, prolonged operation time, estimated blood loss greater than 500 mL, and postoperative hemoglobin levels less than 11 g/dL. Therefore, mothers with identified risk factors should receive preventive measures during the postoperative period until SSI is ruled out.

Incidence and influencing factors for surgical site infections after cesarean section in China: A systematic review and meta-analysis

OBJECTIVE

This study aims to estimate the overall incidence of surgical site infections (SSIs) after cesarean section (CS) and the influencing factors in the Chinese population.

MATERIALS AND METHODS

The study searched all relevant literature in English and Chinese search databases (English search bases: PubMed, Embase, Cochrane Library, Web of Science; Chinese search bases: China National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database) up to March 19, 2024, according to the search strategy. A random/fixed effects model was decided on the basis of the I2 statistic assessing the magnitude of study heterogeneity, and publication bias was assessed using the Begg's test.

RESULTS

After the selection, a final selection of 25 articles was involved. The estimate of post-CS SSIs in China was 2.4% (95%CI: 0.019, 0.029). Age ≥30 years (WMD: 3.8), pre-pregnancy body mass index (BMI) ≥25 kg/m2 (WMD: 1.8), obesity (odds ratio [OR]: 3.0), vaginal cleanliness 3-4 (OR: 4.2), anemia (OR: 1.4), premature rupture of membranes (OR: 2.6), diabetes mellitus (OR: 2.7), National Nosocomial Infections Surveillance System 1-3 (OR: 5.6), emergency surgery (OR: 2.3), trial of labor (OR: 2.9), duration of surgery ≥60 min (OR: 2.0), and intraoperative blood loss >500 mL (OR: 3.5) were the risk factors for post-CS SSIs.

CONCLUSIONS

The rate of post-CS SSIs estimated was 2.4% in China. Both maternal conditions and surgical factors can potentially increase the risk of post-CS SSIs.

Surgical site infection following cesarean section and its predictors in Ethiopia: A systematic review and meta-analysis

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.