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. 2020 Nov 30;20(1):902.
doi: 10.1186/s12879-020-05640-0.

Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: a prospective cohort study

Daniel Bekele Ketema  1 , Fasil Wagnew  2 , Moges Agazhe Assemie  3 , Aster Ferede  3   4 , Alehegn Aderaw Alamneh  5 , Cheru Tesema Leshargie  3   5 , Getiye Dejenu Kibret  3   4 , Pammla Petrucka  6   7 , Animut Takele Telayneh  3 , Animut Alebel  2   4
Affiliations

Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: a prospective cohort study

Daniel Bekele Ketema et al. BMC Infect Dis. .

Abstract

Background: Following delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia.

Methods: A prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association.

Result: The mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study.

Conclusion: This study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.

Keywords: Caesarean section; Incidence; Predictors; Surgical site infection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curve of patients undergoing caesarean section in Debre Markos Referral Hospital between March 28, 2019 and August 31, 2019 by Residence
Fig. 2
Fig. 2
Kaplan-Meier survival curve of patients undergoing caesarean section in Debre Markos Referral Hospital between March 28, 2019 and August 31, 2019 by Type of Surgical Procedure
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