Risk Factors and Bacteriological Profile of Surgical Site Infections Following Cesarean Section: A Single-Center Prospective Cohort Study From Eastern India

BackgroundCesarean section (CS) is the most common obstetric surgical procedure performed in reproductive-age women.Subsequently, wound infections following cesarean delivery are on the rise and contribute significantly to increased patient morbidity. ObjectivesThis study aimed to ascertain the risk factors associated with surgical site infections (SSIs) in cases following CS.The study also aimed to determine the incidence and bacteriological profile of such post-cesarean wound infections. MethodsA single-center prospective observational cohort study was conducted in a tertiary referral hospital during October, 2020 to October, 2021.All women who underwent cesarean delivery within the study period were eligible.All cases were followed up for 30 days for development of SSI, if any.Diagnosis of SSI was made based on criteria defined by the National Healthcare Safety Network (NHSN).Swabs were collected from wound discharge of patients with post-cesarean wound infection and sent to the laboratory for culture.The main outcome measures studied were incidence of SSI post-CS, bacteriological profile of SSI, risk factors associated with SSI, and morbidity resulting from it.The statistical significance of the association of risk factors with SSI was analyzed using the chi-square test with Fisher's exact test for categorical variables, and Student's t-test or analysis of variance (ANOVA) for continuous variables. ResultsThe incidence of SSI in the study was 9.1% (62 out of 683).The most common organism isolated was Staphylococcus aureus in 13/57 (22.8%) cases, followed by Klebsiella species in 11/57 (19.3%) cases, and Escherichia coli in 11/57 (19.3%) cases.Patient factors such as body mass index (BMI)≥25 kg/m 2 , anemia, and pre-gestational or gestational diabetes significantly increased the risk of SSI post-CS.Obstetric factors such as prolonged rupture of membranes ≥ 18 hours, previous CS, surgical variables relating to intraoperative blood loss of more than 1000 mL, and duration of surgery ≥ 1.5 hours were positive risk factors for SSI.The duration of hospital stay in the postoperative period was significantly increased in women with SSI as compared to those without SSI. ConclusionOur study provides an overview of the incidence, bacteriological profile, and associated risk factors for SSI post CS in a single-center setting from Eastern India.These findings could help predict and prevent SSI in women undergoing CS, which is an important cause of patient morbidity and a substantial burden on the healthcare system in a developing country.