Magnitude and Predictors of Post-cesarean Surgical Site Infection in Enugu, Southeast Nigeria

Abstract

Context: Post-cesarean surgical site infection (SSI) is one of the leading causes of maternal morbidity and mortality. It is speculated that there is an increasing incidence of post-cesarean SSI above that reported value a decade ago, especially as the cesarean section (CS) rate and concern for antibiotics resistance increase in Nigeria. Aim: To determine the incidence and predictors of post-cesarean SSI at the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla and Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, Enugu. Settings and Design: Prospective cohort study comprising 160 consenting pregnant women who consented to have a CS at the UNTH and ESUT-TH. Material and Methods: Eligible patients who consented to elective and emergency CS were included, but those with clinical chorioamnionitis were excluded. Surgery was performed by senior resident phsiciansandconsultantsin OBGYN using similar surgical and postoperative protocols. Participants were followed up until 30 days postdelivery to identify those who developed SSI. Statistical Analysis: Statistical analysis was performed using IBM SPSS software version 20.0 (Armonk, NY). The Chi-square test was used to test the association between qualitative variables, while logistic regression was used to determine the predictors of postoperative SSI. The significance level was established at P < 0.05. Result: The incidence of post-cesarean SSI in this study was 13.7%. Maternal booking body mass index ≥30 and postoperative hemoglobin <11.0 g/dl were predictors of post-cesarean SSI. Of the 22 cases of SSI, superficial, deep, and organ/space SSI contributed 63.6%, 31.8%, and 4.6%, respectively. Conclusions: Post-cesarean SSI is high in the study centers and is predictable by maternal obesity at booking and postoperative anemia.