Background
Methods and materials
Study design
Inclusion and exclusion criteria
Sampling procedure and sample size
Data collection
Specimen collection and laboratory procedures
Data analysis
Ethical clearance
Study limitations
Results
Patients’ characteristics
Characteristic | n (%) |
---|---|
Age in years
| |
<20 | 30 (8.7) |
20-34 | 273 (79.1) |
≥ 35 | 42 (12.2) |
Parity
| |
Nulliparous | 127 (36.8) |
1-3 | 180 (52.2) |
≥4 | 38 (11.0) |
Gestational age in weeks
| |
˂ 37 | 68 (20.2) |
≥37 | 268 (79.8) |
Mode of admission
| |
Self | 289 (83.8) |
Referral | 56 (16.2) |
Onset of labor
| |
Spontaneous | 260 (75.4) |
Induced | 21 (6.1) |
No labor | 64 (18.5 |
Type of skin incision
| |
Vertical | 259 (75.1) |
Transverse | 86 (24.9) |
Type of caesarean section
| |
Elective | 26 (7.5) |
Emergency | 319 (92.5) |
Type of skin incision
| |
Transverse | 86 (24.9) |
Vertical | 259 (75.1) |
Number of prior caesarean sections
| |
0 | 214 (62.0) |
1 | 88 (25.5) |
2 | 31 (9.0) |
3 | 10 (2.9) |
4 | 2 (0.6) |
HIV status
| |
Positive | 22 (6.4) |
Negative | 218 (63.2) |
Unknown | 105 (30.4) |
Body mass index (N = 345)
| |
Underweight (<18.5) | 1 (0.3) |
Normal weight (18.5-24.9) | 46 (13.3) |
Overweight (25–29.9) | 162 (45.0) |
Obesity ≥30 | 136 (39.4) |
Indication | N (%) |
---|---|
Previous caesarean delivery | 106 (30.7) |
Fetal distress | 54 (15.7) |
Prolonged labor | 48 (13.9) |
Malpresentation | 32 (9.3) |
Obstructed labor | 28 (8.1) |
Hypertensive disorders of pregnancy | 30 (8.7) |
Antepartum hemorrhage | 9 (2.6) |
Premature rupture of membranes | 7 (2.0) |
Others* | 31 (9.0) |
Total
|
345 (100.00)
|
Magnitude and burden of surgical site infections
Predictors of surgical site infections
Surgical site infection (SSI) | ||||
---|---|---|---|---|
Predictive factors | Yes n (%) | No n (%) | HR (95% CI) | p - value |
Age in years | ||||
>30 | 4 (4.4) | 86 (95.60 | 1.0 | |
≤30 | 30 (11.8) | 225 (88.2) | 2.8 (1.0-7.9) | 0.055 |
Parity | ||||
Multiparas | 19 (8.7) | 119 (91.3) | 1.0 | |
Nulliparous | 15 (11.8) | 112 (88.2) | 1.3 (0.7-2.6) | 0.393 |
BMI‡ | ||||
None obese | 30 (9.6) | 282 (90.4) | 1.0 | |
Obese | 4 (12.1) | 29 (87.9) | 1.3 (0.4-3.6) | 0.647 |
HIV status | ||||
Negative | 23 (10.6) | 195 (89.5) | 1.0 | |
Positive | 4 (18.2) | 18 (81.8) | 1.8 (0.6-5.1) | 0.295 |
Hypertension | ||||
No | 24 (8.3) | 265 (91.7) | 1.0 | |
Yes | 10 (17.9) | 46 (82.1) | 2.2 (1.1-4.7) | 0.031 |
ASA score* | ||||
1 or 2 | 22 (7.8) | 260 (92.2) | 1.0 | |
≥3 | 12 (19.1) | 51 (80.9) | 2.7(1.3-5.5) | 0.005 |
Hemoglobin level in g/dl | ||||
>11 | 24 (10.0) | 217 (90.0) | 1.0 | |
<11 | 10 (10.4) | 86 (89.6) | 1.0 (0.5-2.1) | 0.960 |
Duration of ROM† in hrs | ||||
≤8 | 25 (8.3) | 277 (91.7) | 1.0 | |
>8 | 9 (20.9) | 34 (79.1) | 2.7 (1.3-5.8) | 0.011 |
Number of vaginal exams | ||||
≤3 | 20 (7.1) | 260 (92.9) | 1.0 | |
>4 | 14 (21.5) | 51 (78.5) | 3.3 (1.7-6.5) | 0.001 |
Duration of labor in hrs | ||||
≤12 | 20 (7.3) | 256 (92.7) | 1.0 | |
>12 | 14 (20.3) | 55 (79.7) | 3.0 (1.5-6.0) | 0.002 |
Preop length of stays in hrs | ||||
≤12 | 17 (7.8) | 200 (92.2) | 1.0 | |
>12 | 17 (13.3) | 111 (86.7) | 1.7 (0.9- 3.4) | 0.116 |
Surgical site infection (SSI) | ||||
---|---|---|---|---|
Predictive factors | Yes n (%) | No n (%) | HR (95% CI) | p - value |
Wound class | ||||
Clean or clean-contaminated | 12 (5.9) | 190 (94.1) | 1.0 | |
Contaminated or dirty | 22 (15.4) | 121 (84.6) | 2.7 (1.4-5.5) | 0.005 |
Type of anaesthesia used | ||||
Regional | 32 (9.7) | 298 (90.30 | 1.0 | |
General | 2 (13.3) | 13 (86.7) | 1.5 (0.4-6.5) | 0.551 |
Type of skin incision | ||||
Transverse | 3 (3.5) | 83 (96.5) | 1.0 | |
Vertical | 31 (12.0) | 228 (88.0) | 3.6 (1.1-11.8) | 0.034 |
Duration of procedure in mins | ||||
≤60 | 24 (8.3) | 265 (91.7) | 1.0 | |
>60 | 10 (17.9) | 46 (82.1) | 2.4 (1.1-5.0) | 0.020 |
Type of surgeon | ||||
Senior* | 26 (8.4) | 282 (91.6) | 1.0 | |
Junior** | 8 (21.6) | 29 (78.4) | 2.8 (1.3-6.1) | 0.012 |
Number of people in theatre | ||||
≤5 | 8 (13.8) | 50 (86.2) | 1.0 | |
>5 | 26 (9.1) | 260 (90.9) | 0.7 (0.3- 1.4) | 0.289 |
Estimated blood loss in mls | ||||
≤500 | 25 (9.3) | 245 (90.7) | 1.0 | |
>500 | 9 (12.0) | 66 (88.0) | 1.4 (0.6-2.9) | 0.436 |
Antibiotic used | ||||
Non-ampicillin regimen | 14 (8.2) | 156 (91.8) | 1.0 | |
Ampicillin regimen | 20 (11.5) | 154 (88.5) | 1.4 (0.7- 2.8) | 0.304 |
Duration of antibiotic course | ||||
Single dose | 7 (8.5) | 75 (91.5) | 0.8 (0.4-1.8) | 0.608 |
Multiple doses | 27 (10.3) | 235 (89.7) | 1.0 |
Independent risk factors | HR (95% CI) | P - value |
---|---|---|
Hypertensive disorders of pregnancy | 2.9 (1.4-6.4) | 0.006 |
Contaminated wound | 2.5 (1.2-5.1) | 0.016 |
Multiple vaginal examinations | 2.6 (1.3-5.3) | 0.008 |
Operation done by Intern doctor | 4.2 (1.8-9.5) | 0.001 |
Severe anaemia (Hb <7 g/dl) | 3.8 (1.2-12.4) | 0.028 |
Duration of procedure >60 minutes | 2.3 (1.1-4.8) | 0.030 |