Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 11:3:25.
doi: 10.1186/2047-2994-3-25. eCollection 2014.

Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania

Filbert J Mpogoro  1 , Stephen E Mshana  2 , Mariam M Mirambo  1 , Benson R Kidenya  3 , Balthazar Gumodoka  1 , Can Imirzalioglu  4
Affiliations

Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania

Filbert J Mpogoro et al. Antimicrob Resist Infect Control. .

Abstract

Background: Surgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs.

Methods: This was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11.

Results: The overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6-9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%.

Conclusion: SSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple factors. Strategies to control these factors are urgently needed to control SSIs post CS at Bugando Medical Centre and other centres in developing countries.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of patient recruitment and follow up.
See this image and copyright information in PMC

References

    1. Betrán AP, Merialdi M, Lauer JA, Bing‒Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98–113. doi: 10.1111/j.1365-3016.2007.00786.x. - DOI - PubMed
    1. Dumont A, De Bernis L, Bouvier-olle M-H, Bréart G. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet. 2001;358(9290):1328–1333. doi: 10.1016/S0140-6736(01)06414-5. - DOI - PubMed
    1. Sørbye IK, Vangen S, Oneko O, Sundby J, Bergsjø P. Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania. BMC Pregnancy Childbirth. 2011;11(1):55. doi: 10.1186/1471-2393-11-55. - DOI - PMC - PubMed
    1. Muganyizi P, Kidanto H, Kazaura M, Massawe S. Caesarean section: trend and associated factors in Tanzania. Afr J Midwifery Womens Health. 2008;2(2):65–68. doi: 10.12968/ajmw.2008.2.2.65. - DOI
    1. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725–730. doi: 10.1086/501572. - DOI - PubMed

LinkOut - more resources