Microbiological Microbiological Pattern of Surgical Site Infection Following Caesarean Section at the University of Calabar Teaching Hospital

Abstract

BACKGROUND: Surgical site infection (SSI) is among the most common problems of patients who undergo a caesarean section, despite improved infection control practices. It contributes to increased morbidity and negative impact on the mental, social and economic aspect of patients’ life.

AIM: To determine the incidence, risk factors and the bacteriological aetiology for SSI following caesarean section and their antimicrobial susceptibility patterns at UCTH.

METHODS: This was a prospective study of 600 patients who had a caesarean section over 6 months. Wound swab was collected from the patients who developed clinical evidence of SSI during this study period were recorded. Microbiology culture and antibiotic sensitivity were conducted for both aerobic and anaerobic organisms. The data obtained were analysed using the SPSS version 22 statistical program.

RESULTS: Out of the 600 participants who had a caesarean section, 51 patients had SSI, giving an incidence of 8.5%. The common isolates were S. aureus (37.3%), Klebsiella pneumonia (27.1%) and E. coli (22.0%). Independent risk factors significantly associated with post caesarean section wound infection in the logistic regression model were emergency caesarean section, prolonged rupture of membrane rupture greater than 24 hours, prolonged labour, intra-operative blood loss greater than one litre, duration of surgery greater than one hour and post-operative PCV less than 30%. Most isolates were highly resistant to cephalosporins, gentamycin and amoxicillin; moderately resistant to fluoroquinolones and highly sensitive to amikacin and imipenem.

CONCLUSION: The post-caesarean wound infection rate in our centre of 8.5% was high. Imipenem and amikacin antibiotics were very sensitive for SSIs and can be used as evidenced-based sensitive antibiotics to be commenced initially when wound infection is identified in our wards while awaiting the result of wound swab microscopy, culture and sensitivity to reduce the complications of post-caesarean wound infection in our centre.