DOI: https://doi.org/10.14710/jekk.v9i1.19423

The Prevalence and The Association of Antibiotic Practices with Surgical Site Infection Following Cesarean Section

*Maiga Ayub Hussein  -  Nexus Centre for Research and Innovations (NCRI), Uganda
Dwi Sutiningsih  -  Universitas Diponegoro, Indonesia
Saidi Ntambi  -  Nexus Centre for Research and Innovations (NCRI), Uganda
Chebet Frida  -  Mulago National Refferal Hospital, Uganda
Received: 12 Dec 2023; Published: 28 Feb 2024.

Citation Format:
Abstract

Background: This study focuses on Cesarean section (CS) procedures and the associated risk of surgical site infections (SSIs). The global CS rate is currently at 21%, higher than the recommended 15%, leading to an increased risk of SSIs. These infections are a significant burden on economies, healthcare systems, patients, and their families, despite being preventable. The research aims to address the issue in Uganda, where the burden of SSIs stands at 15.5%. While previous studies have examined various risk factors, such as age, parity, surgeon expertise, and antiseptic solutions, there is a lack of research on pre- and post-CS antibiotic practices and their connection to SSIs. This study seeks to establish the prevalence of SSIs and evaluate the antibiotic practices before and after CS procedures at Mbale Regional Referral Hospital from January 1, 2020, to December 31, 2022.

Methods: The design was retrospective cross-sectional. Consecutively selected 104 patient files that developed SSIs and randomly an equal number of patient files that did not develop SSIs to make up a sample size of 208 files that were reviewed at Mbale regional referral hospital (MRRH) from 1st –January -2020 to 31st -December-2022.

Result: The prevalence of surgical site infections (SSIs) was 4.3%. Among the 208 patient files reviewed, 71.2% received antibiotic prophylaxis, with intravenous ceftriaxone being the most common (47.1%). However, only 14.9% received prophylaxis within the recommended 30-60 minutes before incision. Post-cesarean section, 92.8% received intravenous ceftriaxone and metronidazole, and the mean hospital stay was 2.74 days. Factors significantly associated with reduced SSI risk were the timing of antibiotic prophylaxis, administration of intravenous antibiotics post-cesarean, oral antibiotics post-cesarean, duration of hospital stay, and the cadre of the surgeon

Conclusion: The prevalence of surgical site infections (SSIs) at Mbale Regional Referral Hospital (MRRH) was found to be 4.3%. This study highlighted several factors that were associated with a reduced risk of SSIs in women undergoing Cesarean section (CS), including timely administration of antibiotic prophylaxis within 30-60 minutes before the incision, the use of post-CS intravenous (IV) ceftriaxone and metronidazole, hospital stays of 3 days, oral cefixime upon discharge, and being operated on by a medical officer

Recommendation: The study emphasizes the importance of medical professionals following guidelines and acquiring knowledge on appropriate antibiotic use to combat surgical site infections (SSIs) following cesarean sections. Adhering to guidelines and continuous education is crucial in preventing SSIs and addressing antibiotic resistance

Fulltext View|Download
Keywords: Antibiotic; surgical site infections (SSIs); cesarean section
Funding: Universitas Diponegoro

Article Metrics:

Article Info
Section: Articles
Language : EN
Recent articles
Hubungan Anak Wasting dengan Penyakit Infeksi Saluran Pernapasan Akut di Kota Salatiga Analisis Spasial Faktor-Faktor yang Mempengaruhi Kejadian Tuberkulosis di Malang Raya Tahun 2020-2021 Health Behavior pada Pasien HIV AIDS di Kota Salatiga More recent articles
  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, C., Bartlett, L., et al., 2012. Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: A chart review. BMC Pregn. Child.12
  3. Riad, N., Younes, and Tayna, F. 2021. Farias2 RASS. Intern. J. Infect. Prevent. 2:29–47
  4. 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
  5. Kurigamba, G.K., Dianah, Nanyanga, I., Nahabwe, H., and Mutahunga, B.R. 2018. Post cesarean wound sepsis : Recognizable risks and causes at a Rural Ugandan Hospital. Int. J. Women’s Health Care : 6–9
  6. Kawakita, T., and Landy, H.J. 2017. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern. Heal. Neonatol. Perinatol. 3(1):1–9
  7. Waniala, I., Nakiseka, S., Nambi, W., Naminya, I., Ajeni, M.O., Iramiot, J., et al. 2020. Prevalence, indications, and community perceptions of caesarean section delivery in Ngora District , Eastern Uganda : Mixed method study. 2020
  8. Jithin. 2023. Multi-Drug Resistant organisms associated surgical site infection - a case report international clinical and medical case reports journal case report article multi-drug resistant organisms associated surgical site infection - a Case Re. April
  9. Arcy, N.D., Ashiru-oredope, D., Olaoye, O., Afriyie, D., Akello, Z., 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
  10. NICE. 2020. Surgical site infections: prevention and treatment CG74. Clin Guidel Insitute Health care Excell [Internet]. August 2020:1–29. Available from: www.nice.org.uk/guidance/ng125
  11. Isanga, J., Emmanuel, B., Musa, K., Julius, M., Tibaijuka, L., 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 Health Care. 5(1):5–10
  12. Alfouzan, W. 2019. Surgical site infection following cesarean section in a general hospital in Kuwait : Trends and risk factors
  13. Sarah, N. 2015. Risk factors for post cesarean wound infection among mothers. (November)
  14. Gomaa, K., Abdelraheim, A.R., Gelany, S E.l., Khalifa, E.M., Yousef, A.M., and Hassan, H. 2021. Incidence, risk factors and management of post-cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt : a five-year retrospective study. 3:1–9
  15. Lubega, A., Joel, B., Justina, and Lucy N. 2017. Incidence and etiology of surgical site infections among emergency postoperative patients in Mbarara Regional Referral Hospital, South Western Uganda. Surg Res Pract
  16. OECD, WHO, FAO, and OIE. 2017. Tackling antimicrobial resistance ensuring sustainable R&D. G20 Summit Hamburg, 29 June 2017. Final note prepared by OECD, WHO, FAO and OIE. 2017 (June):37. Available from: http://www.oecd.org/g20/summits/hamburg/Tackling-Antimicrobial-Resistance-Ensuring-Sustainable-RD.pdf
  17. Abdelraheim, A.R., Gomaa, K., Ibrahim, E.M., Mohammed, M.M., Khalifa, E.M., Youssef, A.M., et al. 2019. Intra-abdominal infection (IAI) following cesarean section: A retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy Childbirth.;19(1):1–7
  18. Kalibushi, Bizimana, J., Ndoli, J., Bayingana, C., Baluhe, I., Gilson, G.J., and Habimana, E. 2016. Rwanda 4 Infection prevention and control coordinator CHUB, Rwanda 5 instructor at Department of Obstetrics and Gynecology, HRH Rwanda, Maternal Fetal Medicine Physician at Alaska Native Tribal Health Consortium (ANTHC), Rwanda 6 Senior Resident in Obstet. Orig Res Artic Univ Teach Hosp [Internet]. ;5(6):631–41. Available from: http://dx.doi.org/10.20546/ijcmas.2016.506.069http://www.ijcmas.com
  19. Alfouzan, W., Al Fadhli, M., Abdo, N., Alali, W., and Dhar, R. 2019. Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors. Epidemiol. Infect. 147:e287
  20. Kelly, V.Y., Yerba, K., Failoc-rojas, V., Zeña-ñañez, S., and Valladares-M. 2020. Factors Associated with Surgical Site Infection in Post-Cesarean Section : A Case-Control Study in a Peruvian Hospital. :10–15
  21. Nkurunziza, T., Kateera, F., Sonderman, K., Gruendl, M., Nihiwacu, E., Ramadhan, B., et al. 2019. Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda. :121–128
  22. 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
  23. Sway, A., Nthumba, P., Solomkin, J., Tarchini, G., Ren, Y., Wanyoro, A., et al. 2020. 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
  24. 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
  25. Skjeldestad, F.E., Bjørnholt, J.V., Gran, J.M., Erisken H.M. 2015. The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery. Int. J. Gynecol. Obstet. 128(2):126–30. Available from: http://dx.doi.org/10.1016/j.ijgo.2014.08.018
  26. Jabs, C., Giroux, M., Minion, J., Karreman, E., 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
  27. WHO. 2017. Managing complications in pregnancy and childbirth
  28. MoH-Uganda. 2015. The Republic of Uganda practical guideline for dispensing at higher level health centres
  29. Roy, S. 2016. Bacteriological profile of post-operative wound infection
  30. Lubega, A., Joel, B., Justina, and Lucy, N. 2017. Incidence and etiology of surgical site infections among emergency postoperative patients in Mbarara Regional Referral Hospital, South Western Uganda. Surg. Res. Pract
  31. 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;1–10. Available from: http://dx.doi.org/10.1038/s41598-019-53712-2
  32. Victoria, K. 2015. Antibiotic resistance in Uganda: Situation analysis and recommendations [Internet]. Uganda National Academy of Sciences. 2015. 1–94 p. Available from: www.ugandanationalacademy.org
  33. Kutyabami, P., Munanura, E.I., Kalidi, R., Balikuna, S., Ndagire, M., Kaggwa, B., et al. 2021. Evaluation of the clinical use of ceftriaxone among in-patients in Selected Health Facilities in Uganda
  34. Jasim, H.H., Azhar, S., Sulaiman, S., Khan, A.H., Dawood, O.T., Abdulameer, A.H., et al. 2017. Incidence and risk factors of surgical site infection among patients undergoing cesarean section
  35. Kvalvik, S.A., Rasmussen, S., Thornhill, H.F., and Baghestan, E. 2021. Risk factors for surgical site infection following cesarean delivery: A hospital-based case–control study. Acta. Obstet. Gynecol Scand.;100(12):2167–75
  36. Rodrigues, D.O., and da Mata Silva E.T. 2022. Risk factors for surgical site infection: challenges to public health. J Microbiol Exp.10(1):1–8
  37. Mujagic E, T. Z, H. H, H. M, L. I, C.A. N, et al. 2014. Evaluating the optimal timing of surgical antimicrobial prophylaxis: Study protocol for a randomized controlled trial. Trials;15(1):1–11. Available from: http://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-188%0Ahttp://europepmc.org/search?query=(DOI: 10.1186/1745-6215-15-188)%0Ahttps://trialsjournal.biomedcentral.com/track/pdf/10.1186/1745-6215-15-188?site=trialsjournal.biomedcentral.com
  38. 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) : 12-17

Last update:

No citation recorded.

Last update:

No citation recorded.