LOWER SEGMENT CESARIAN SECTION SURGICAL SITE INFECTION: RISK FACTOR AND MICROBIAL ETIOLOGY

Abstract

INTRODUCTION: Lower Segment Cesarean Section (LSCS) delivery is a major obstetrical surgical procedure to save the lives of mothers and fetus. Various risk factors in SSI following LSCS has been identified which includes subcutaneous hematoma, subcutaneous hematoma, tobacco use in pregnancy, incision length > 16.6 cm , body mass index >30 or 35 kg/m2, prolonged second stage (compared with first stage) , no antibiotic prophylaxis, duration of labor >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery. Diagnosis of surgical site infection requires evidence of clinical signs and symptoms of infection which may be further supported by microbiological evidence.
 MATERIAL AND METHODS: A total of 646 patients were included in the study of which 27 were diagnosed as SSI. Risk factor for SSI was divided into three categories: 1) host-related factors, 2) pregnancy and intrapartum-related factors, and 3) procedure-related factors.
 RESULTS: Among 646 cesarean sections, surgical site infection was observed in 27(4.1%) cases while he remaining cases had no surgical site infection. Mean age of cases with surgical site infection was observed to be 14.8 years with sd of 3.9 years where as it was 22.1 years in cases with no surgical site infections and sd of 3.2 years. Average number of stay in hospital is found to be 14.1 and 7.3 days respectively in cases with and without surgical site infections. Antibiotics were given on 17.3 days on average in cases with SSI whereas patients without surgical site infections were on antibiotics for 3.1 days on average. Out of total 27 surgical site infection E-coli was isolated in 11(40.8%) cases followed by 7(25.9%) isolations of staphylococcus aureus. Klebsiella pneumonia and pseudomonas aeruginosa were isolated in 3(11.1%) cases each. Acitenobacter was found in only 1(3.7%) case. 2(7.4%) isolates were not identified in our study.
 CONCLUSION: To reduce the SSI rates post LSCS, proper assessment of risk factors and their modification is required. Frequent antibiotic susceptibility testing for resistance is required.