DOI: https://doi.org/10.14710/jekk.v9i2.18878

Antibiotic Practices and The Rate of Surgical Site Infection Following Cesarean Section

*Maiga Ayub Hussein  -  Nexus Centre for Research and Innovations (NCRI), Uganda
Dwi Sutiningsih  -  Universitas Diponegoro, Indonesia
Ntambi Saidi  -  Nexus Centre for Research and Innovations (NCRI), Uganda
Chebet Frida  -  Mulago National Referral Hospital, Uganda
Mateus Sakundarno Adi  -  Universitas Diponegoro, Indonesia
Received: 6 Apr 2024; Published: 31 Aug 2024.

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Abstract

Background: Cesarean section (CS) is the most performed operation globally. It’s a clean-contaminated surgery with higher surgical site infections (SSIs) risk. The mortality rate associated with cesarean section in Africa is 50 times greater than in high income settings, 11 women die per 1000 CS in sub-Saharan Africa and 14% of women suffer complication (SSIs). Proper antibiotic use can reduce this burden however effective antibiotics are running out due to inappropriate use. This study aimed to assess the pre-cesarean and post-cesarean antibiotic practices and the rate of SSIs following CS at Mbale regional referral hospital (MRRH)

Methods: The study was a retrospective and descriptive cross-sectional on CS mothers between 1st January 2020 and 31st December 2022 at MRRH.  Out of the 2432 patient files reviewed, an equal number (104) of women who developed SSIs and those that did not develop SSIs (104) were selected by simple random sampling, total sample size of 208.

Result: More than half (n=148; 71.2 %.) received antibiotic prophylaxis. Majority received I.V ceftriaxone (38.0%) within 15minutes (mean duration) before skin incision. 35.1% of 208 that received antibiotic prophylaxis developed SSIs. I.V Metronidazole and Ceftriaxone were the most administered after CS and Oral metronidazole was the most prescribed upon discharge.

Conclusion : The rate of SSIs at MRRH was 3% similar to that of Mbarara regional referral hospital at 3.5%. Lack of antibiotics prophylaxis and poor antibiotic prophylaxix timing could explain this rateu underscoring compliance to International, National and Hospital surgical bundles.

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Keywords: Antibiotic; surgical site infections (SSIs); cesarean section

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  1. Bizuayew, H., Abebe, H., Mullu, G., and Bewuket, L. 2021. Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals , Amhara region, North West. 77:1–15
  2. Kim, Y.M., Tappis, H., Zainullah, P., Ansari, N., Evans, and C., Bartlett, L., et al. 2012. Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: A chart review. BMC Pregnancy Childbirth. 12
  3. Saeed, K.B., Corcoran, P., and Greene, R.A. 2019. Incisional surgical site infection following cesarean section: A national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol [Internet]. 240:256–60. Available from: https://doi.org/10.1016/j.ejogrb.2019.07.020
  4. Riad, N., Younes, and Tayna, F. 2021. Farias2 RASS. Int J. Infec. Prevent. (2):29–47
  5. Gong, S.P., Guo, H.X., Zhou, H.Z., Chen, L., and Yu, Y.H. 2012. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res. 38(3):509–15
  6. Kurigamba, G.K., Dianah, Nanyanga, I., Nahabwe, H., and Mutahunga, B.R. 2018. Post ceserean wound sepsis : Recognizable Risks and Causes at a Rural Ugandan Hospital. Int J Women ’ s Heal Care. 6–9
  7. Kawakita, T., Landy, H.J. 2017. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Heal Neonatol Perinatol. 3(1):1–9
  8. Waniala, I., Nakiseka, S., Nambi, W., Naminya, I., Ajeni, M.O., and Iramiot, J., et al. 2020. Prevalence, indications, and community perceptions of caesarean section Delivery in Ngora District , Eastern Uganda : Mixed Method Study. 2020
  9. Smaill, F.M., and Grivell, R.M. 2014. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014(10)
  10. Jithin. 2023. Multi-Drug resistant organisms associated surgical site infection a case report international clinical and medical case reportsjournal case report article (ISSN : 2832-5788) multi-drug resistant organisms associated surgical site infection - a case re. (April)
  11. Arcy, N.D., Ashiru-oredope, D., Olaoye, O., Afriyie, D., Akello, Z., and Ankrah, D., et al. 2021. Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals : Results from the Global Point Prevalence Survey (G-PPS) on antimicrobial use and stewardship interventions implemented. 1–15
  12. Schrufer-Poland, T.L., Ruiz, M.P., Kassar, S., Tomassian, C., Algren, S.D., and Yeast, J.D. 2016. Incidence of wound complications in cesarean deliveries following closure with absorbable subcuticular staples versus conventional skin closure techniques. Eur J Obstet Gynecol Reprod Biol 206:53–6. Available from: http://dx.doi.org/10.1016/j.ejogrb.2016.07.501
  13. Llor, C., and Bjerrum, L. 2014. Antimicrobial resistance : risk associated with antibiotic overuse and initiatives to reduce the problem. 229–41
  14. Ngonzi, J., Tornes, Y.F., Mukasa, P.K., Salongo, W., Kabakyenga, J., Sezalio, M., et al. 2016. Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda. BMC Pregnancy Childbirth 16(1):1–7. Available from: http://dx.doi.org/10.1186/s12884-016-0986-9
  15. Isanga, J., Emmanuel, B., Musa, K., Julius, M., Tibaijuka, L., and Ronald, M., et al. 2020. The prevalence, risk factors, and bacterial profile of cesarean surgical site infections at a University Teaching Hospital in South Western Uganda. Int J Women’s Heal Care. 5(1):5–10
  16. WHO,. 2017. Managing complications in pregnancy and childbirth
  17. Victoria, Katawera. 2015. Antibiotic resistance in Uganda: situation analysis and recommendations [Internet]. Uganda National Academy of Sciences. 1–94 p. Available from: www.ugandanationalacademy.org
  18. OECD, WHO, and FAO O. 2017. Tackling antimicrobial resistance ensuring sustainable R&D. G20 Summit Hamburg, 29 June 2017. Final note prepared by OECD, WHO, FAO and OIE. (June):37. Available from: http://www.oecd.org/g20/summits/hamburg/Tackling-Antimicrobial-Resistance-Ensuring-Sustainable-RD.pdf
  19. Belise, U.S., and Christian, N. 2022. One health approach to combat antibiotic resistance in developing countries. 7–10
  20. Pinchera, B., Buonomo, A.R., Schiano, Moriello, N., Scotto, R., Villari, R., and Gentile, I. 2022. Update on the Management of Surgical Site Infections. Antibiotics. 11(11)
  21. Dougan, G., and Kariuki, S. 2014. Antibacterial resistance in sub-Saharan Africa: an underestimated emergency. Ann N Y Acad Sci. 1323,1(1):43–55
  22. WHO. 2015. Antimicrobial Resistance. 1–6
  23. Hope, D., Ampaire, L., Oyet, C., Muwanguzi, E., Twizerimana, H., and Apecu, R.O. 2019. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital , Southwestern Uganda. Sci Rep [Internet]. 1–10. Available from: http://dx.doi.org/10.1038/s41598-019-53712-2
  24. Yang, X., Xiao, X., Wang, L., Ao, Y., Song, Y., Wang, H., et al. 2018. Application of antimicrobial drugs in perioperative surgical incision. Ann Clin Microbiol Antimicrob. 17(1)
  25. Sway, A., Nthumba, P., Solomkin, J., Tarchini, G., Ren, Y., and Wanyoro, A., et al. 2022. Burden of surgical site infection following cesarean section in sub-Saharan Africa : a narrative review Burden of surgical site infection following cesarean section in sub-Saharan Africa : a narrative review. Available from: https://doi.org/10.2147/IJWH.S182362
  26. Jasim, H.H., Azhar, S., Sulaiman, S., Khan, A.H., Dawood, O.T., and Abdulameer, A.H., et al. 2017. Incidence and risk factors of surgical site infection among patients undergoing cesarean section
  27. Hou, Y., Collinsworth, A., Hasa, F., and Grif, L. 2023. Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures. 11:1–18
  28. Jabs, C., Giroux, M., Minion, J., Karreman, E., and Faires, M. 2021. Evaluation of adjunctive azithromycin prophylaxis in women undergoing cesarean delivery in a setting with low baseline incidence of surgical site infection. J Obstet Gynaecol Canada 43(9):1062-1068.e2. Available from: https://doi.org/10.1016/j.jogc.2020.12.016
  29. Mpogoro, F.J., Mshana, S.E., Mirambo, M.M., Kidenya, B.R., and Gumodoka, B. 2014. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre , Mwanza , Tanzania. 3(1):1–10
  30. Alfouzan, W. 2019. Surgical site infection following cesarean section in a general hospital in Kuwait : trends and risk factors
  31. Eyk, N. Van, and Schalkwyk, J. Van. 2022. No . 275-Antibiotic prophylaxis in gynaecologic procedures. J Obstet Gynaecol Canada. 40(10):e723–33. Available from: https://doi.org/10.1016/j.jogc.2018.07.007
  32. Kambale, G., and Paluku, M. 2020. Infection prevention in practice compliance of antibiotics used for surgical site infection prophylaxis among patients undergoing surgery in a Congolese teaching hospital. 2
  33. Morioka, H., Ohge, H., Nagao, M., Kato, H., Kokado, R., and Yamada, K., et al. 2022. Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals. J Hosp Infect 129:189–97. Available from: https://doi.org/10.1016/j.jhin.2022.06.017
  34. Skjeldestad, F.E., Bjørnholt, J. V., Gran, J.M.,and Erisken, H.M. 2014. The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery. Int J Gynecol Obstet [Internet]. 2015;128(2):126–30. Available from: http://dx.doi.org/10.1016/j.ijgo. 08.018
  35. Smaillfile. 2014. Antibiotic prophylaxis versus no prophylaxis for preventing infection a er cesarean section (Review)
  36. Yan, W., Machowska, A., Sihavong, A., Sychareun, V., Vongsouvath, M., and Brauner. A, et al. 2022. Antibiotic prescribing in connection to childbirth : an observational study in two districts in Lao PDR. 1–11
  37. Part, R., Caughey, A.B., Wood, S.L., Macones, G.A., Wrench, I.J., and Chb, M.B., et al. 2018. Guidelines for intraoperative care in cesarean delivery : Enhanced recovery after surgery society. Am J Obstet Gynecol. 219(6):533–44. Available from: https://doi.org/10.1016/j.ajog.2018.08.006
  38. Gupta, S., Manchanda, V., Sachdev, P., Kumar R., and Joy, M. 2021. Study of incidence and risk factors of surgical site infections in lower segment caesarean section cases of tertiary care hospital of north India. Indian J Med Microbiol 39(1):1–5. Available from: https://doi.org/10.1016/j.ijmmb.2020.11.005
  39. Kutyabami, P., Munanura, E.I., Kalidi, R., Balikuna, S., Ndagire, M., and Kaggwa, B., et al. 2021. Evaluation of the clinical use ofceftriaxone among in-patients in selected health facilities in Uganda
  40. Lubega, A., Joel, B., and Justina, L.N. 2017 Incidence and etiology of surgical site infections among emergency postoperative patients in Mbarara Regional Referral Hospital, South Western Uganda. Surg Res Pract
  41. Dahiya, P., Gupta, V., Pundir, S., and Chawla, D. 2016. Study of incidence and risk factors for surgical site infection after cesarean section at first referral unit. 3(4):1102–4
  42. MoH-Uganda. 2016. U ganda Clinical
  43. Guidelines
  44. MoH-Uganda. 2015. The Republic of Uganda practical guideline for dispensing at higher level health centres

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