Appropriateness of surgical antibiotic prophylaxis and factors associated with surgical site infection following lower segment caesarean section: A prospective observational study

Objective: To assess the appropriateness of surgical antibiotic prophylaxis (SAP) use and its adherence to institutional guidelines, and to identify factors associated with surgical site infection (SSI) occurrence in lower segment caesarean section (LSCS) patients. Methods: A prospective observational study was conducted among women undergoing LSCS in Jubilee Mission Medical College and Research Institute, Thrissur, India. SAP appropriateness (antibiotic selection, timing, and duration) was evaluated, and participants were followed for six weeks postoperatively. Associations with SSI were analysed using chi -square and Fisher’s exact tests. Results: The overall SSI rate among the 80 women was 15.0%, all superficial. SAP adherence was 60.0% for antibiotic choice, 55.0% for timing, and 53.8% for duration. Younger women (⩽30 years) had significantly higher SSI rates compared with older women (21.6% vs 3.4%; P =.04). No significant association was observed between SSI and gestational diabetes, timing category, or antibiotic regimen group. Emergency LSCS had a higher SSI incidence than elective procedures (22.7% vs 5.6%; P =.03). The predominant organisms isolated were Escherichia coli , Klebsiella spp., and Staphylococcus aureus . Conclusions: Gaps in SAP adherence particularly in antibiotic selection and timing were identified, with younger age and emergency surgery associated with higher SSI occurrence. Ensuring the availability of recommended first-generation cephalosporins, standardising SAP protocols, and strengthening antimicrobial stewardship are essential to improve surgical outcomes following LSCS and reduce antimicrobial resistance.