Post Caesarean Section Infections At The Korle-Bu Teaching Hospital

ABSTRACT

Background: Caesarean section (CS) is one of the most frequent surgical procedures performed on women worldwide. Post CS wound infection is a major cause of prolonged hospital stay, complicating 3% to 15% of CS procedures worldwide. Surgical site infections (SSI) are associated with a maternal mortality rate of up to 3%.  With the continuous increase in the rate of CS procedures performed, it is expected that post CS infections will increase in parallel, hence its significance.

Aim: This study aimed at determining the organisms associated with post CS infections and their antimicrobial susceptibility patterns. Risk factors that predispose individuals to infections after CS were also determined.

Methodology: Women who underwent CS procedures at the Korle-Bu Teaching Hospital (KBTH) between April – Dec 2017 were surveyed. Wound swabs were collected from study participants who developed post CS infections within 30 days after surgery for culture and susceptibility tests. Bacterial isolates that were multi drug resistant were further screened for antibiotic resistance markers using PCR methods. The markers assayed included mecA and ESBL genes. A structured questionnaire was used to assess risk factors associated with post CS infections.

Results: This study included 907 women who underwent CS, of which 134 developed infections. Post CS infection prevalence was 14.8% (134/907). One hundred and nineteen (119) isolates were cultured from the 134 wound swabs collected. Staphylococcus aureus was the most frequent organism isolated 19.3% (23/119). Coagulase negative Staphylococcus 17.6% (21/119), Escherichia coli 14.3% (17/119) and Pseudomonas aeruginosa 13.4% (16/119) were other frequently isolated organisms. Thirteen (13) out of 23 (56.6%) S. aureus and 18 out of 21 (85.7%) Coagulase Negative Staphylococcus were methicillin resistant. Six (6) out of 17 (35.2%) Escherichia coli and 4 out of 12 (33.3%) Klebsiella species were ESBLs. CTX-M, TEM and SHV types were the genes encoding ESBL among the Enterobacteriaceae. The most significant risk factors found to increase the risk of developing an infection after CS were labour before CS procedure, length of surgery, use of general anaesthesia and the use of stagnant water as scrub water. 

Conclusion: There is a high prevalence of post CS wound infections at the KBTH with a variety of organisms being implicated, predominantly S. aureus. It was also found that multidrug resistant organisms were prevalent. Risk factors associated with post CS infections consisted sociodemographic, obstetric and intuitional factors.