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 foetus. Surgical site infections (SSI) are the most common reason about 20% to be unplanned admitted after discharging of the patient to their home. 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 labour >12 h , premature rupture of membranes , gestational diabetes, previous cesarean delivery and emergency delivery.
 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. Purulent discharge was obtained from the surgical incision site 48 hours postoperatively with sterile disposable swabs. Blood sample for blood culture was collected when the possibility of septicemia or bacteremia as suggested by the presence of fever, shock, or other signs and symptoms of sepsis associated with the surgical wound. The bacterial isolates obtained were identified as per standard identification procedures in time microbiology laboratory. Antibiotic susceptibility of the organisms done as per protocol.
 RESULTS: A total of 646 patients were included in the study of which 94 (14.55%) were diagnosed as SSI. mean age of patients who underwent LSCS was 24± 4.57 years. Of the 646 patients in 18 - 20 years 125 (19.3%),21-25 years 304 (47.1%), 26-30 years 189 (29.3%) and in > 30 years age group 28 (4.3%) cases were observed, of the total 94 SSI cases 11 (8.8%) were in the age group if 18 - 20 years, 39 (12.8%) were in the age group of 21-25 years, 32 (16.9%) were in 26-30 years age group and 12 (42.9%) were in the > 30 years age group. Acinetobacter spies was the commonest isolate 29(30.9%) followed by staphylococcus aureus 22 (23.4%), Escherichia coli 21 (22.3%) and Klebsiellapneumoniae. premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be statistically significant. It was interpreted that PROM > 24 hrs is likely to increase the chances of infection. As the duration of hospital stay increases by 1 day, the chances of infection increase.
 CONCLUSION: Identification, management and proper assessment of risk factors are necessary to in reduction of SSI rates. Premature rupture of membrane (PROM), antibiotics given earlier than 2 hours, BMI >25 and increased duration of stay in the hospital were associated with increased SSI rate.