Prevalence, risk factors, and bacterial pathogens responsible for surgical site infection after caesarean section: a retrospective study

Authors

  • Oleta Pluck Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation, Georgetown, Guyana
  • Amanda D. Gray Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation, Georgetown, Guyana
  • Latoya Z. Young Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation, Georgetown, Guyana
  • Rohini A. Rupan Department of Obstetrics and Gynecology, Georgetown Public Hospital Corporation, Georgetown, Guyana

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253875

Keywords:

Surgical site infection, Risk factors, Prolonged rupture of membranes, Prevalence, Caesarean section, E. coli, Klebsiella pneumoniae

Abstract

Background: Surgical site infection (SSI) is one of the most common complications following caesarean section (CS), with a reported incidence of 3-20%. SSIs cause a significant burden on both the mother and the healthcare system and are associated with maternal morbidity and mortality rates of up to 3%.

Methods: A hospital-based retrospective study was conducted. Of 703 patient charts reviewed, 51 met the inclusion criteria. Data were extracted from medical records and analyzed using Statistical Package for the Social Sciences (SPSS).

Results: The prevalence of SSI was 7.3%. Most cases (96.1%) were classified as Class I SSI, while 3.9% were Class II; no cases of organ-space infection were identified. The mean age of affected patients was 27.5 years. Obesity was present in 68.8% of the cohort. The SSI rate was 17.6% among patients with rupture of membranes (ROM) before CS. Prolonged rupture of membranes (>18 hours) occurred in 13.7% of cases, while ROM <18 hours was noted in 3.9%. Anemia and postpartum hemorrhage each accounted for 2% of associated conditions.

Conclusions: At Georgetown Public Hospital, SSI following caesarean delivery remains a significant complication, with a prevalence of 7.5%. The most commonly isolated organisms were Staphylococcus aureus, followed by Escherichia coli, Klebsiella pneumoniae, and MRSA. Efforts to reduce preventable risk factors are essential to decreasing the overall burden of SSI after caesarean section.

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References

World Health Organization. Global guidelines for the prevention of surgical site infection, 2018. Available at: https://www.who.int/publications/i/item/9789241550475. Accessed 01 June 2025.

Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: prevalence, impact, prevention, and management challenges. Int J Womens Health. 2017;9:81-8. DOI: https://doi.org/10.2147/IJWH.S98876

Saeed KBM, Greene RA, Corcoran P, O’Neill SM. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol. BMJ Open. 2017;7(1):e013037. DOI: https://doi.org/10.1136/bmjopen-2016-013037

National Healthcare Safety Network (NHSN) Patient Safety Component Manual Chapter 17: CDC/NHSN Surveillance Definitions for Specific Types of Infections Chapter 14: Antimicrobial Use and Resistance (AUR); 2020. https://www.cdc.gov/ nhsn/pdfs/validation/2020/pcsmanual_2020-508.pdf. Accessed on 01 October 2025.

Gelaw KA, Aweke AM, Astawesegn FH, Demissie BW, Zeleke LB. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia. Patient Safety in Surgery. 2017;11(1):131-3. DOI: https://doi.org/10.1186/s13037-017-0131-3

World Health Organization. WHO statement on caesarean section rates, 2015. Available at: https://www.who.int/publications/i/item/WHO-RHR-15.02. Accessed 01 June 2025.

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. Trends and determinants of cesarean section rates: a global review. PLOS ONE. 2016;11(2):e0148343. DOI: https://doi.org/10.1371/journal.pone.0148343

Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98-113. DOI: https://doi.org/10.1111/j.1365-3016.2007.00786.x

Notzon FC, Placek PJ, Taffel SM. Comparisons of national cesarean-section rates. Obstetr Gynecolog Surv. 1987;42(8):506-8. DOI: https://doi.org/10.1097/00006254-198708000-00010

Blumenfeld YJ, El-Sayed YY, Lyell DJ, Nelson LM, Butwick AJ. Risk factors for prolonged postpartum length of stay following cesarean delivery. Am J Perinatol. 2015;32(9):825-32. DOI: https://doi.org/10.1055/s-0034-1543953

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;(10)13:606-8. DOI: https://doi.org/10.1086/646436

Olsen MA, Butler AM, Willers DM, Gross GA, Hamilton BH, Fraser VJ. Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery. Infect Control Hosp Epidemiol. 2010;31(3):276-82. DOI: https://doi.org/10.1086/650755

Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):599-605. DOI: https://doi.org/10.1086/646435

Keely Boyle K, Rachala S, Nodzo SR. Centers for Disease Control and Prevention 2017 Guidelines for Prevention of Surgical Site Infections: Review and Relevant Recommendations. Current Reviews in Musculoskeletal Medicine. 2018;11(3):357–69. DOI: https://doi.org/10.1007/s12178-018-9498-8

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91. DOI: https://doi.org/10.1001/jamasurg.2017.0904

Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving riskadjusted measures of surgical site infection for the National Healthcare Safely Network. Infect Control Hosp Epidemiol. 2011;32(10):970-86. DOI: https://doi.org/10.1086/662016

Raka L. Prevention and control of hospital-related infections in low and middle income countries. Open Infect Dis J. 2010;4:125-31. DOI: https://doi.org/10.2174/1874279301004010125

Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect DisObstet Gynecol. 2000;8(2):77-82. DOI: https://doi.org/10.1002/(SICI)1098-0997(2000)8:2<77::AID-IDOG3>3.0.CO;2-6

Yokoe DS, Noskin GA, Cunningham SM, Zuccotti G, Plaskett T, Fraser VJ, et al. Enhanced identification of postoperative infections among inpatients. Emerg Infect Dis. 2004;10(11):1924-30. DOI: https://doi.org/10.3201/eid1011.040572

Opøien HK, Valbø A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102. DOI: https://doi.org/10.1080/00016340701515225

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Published

2025-11-27

How to Cite

Pluck, O., Gray, A. D., Young, L. Z., & Rupan, R. A. (2025). Prevalence, risk factors, and bacterial pathogens responsible for surgical site infection after caesarean section: a retrospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(12), 4125–4131. https://doi.org/10.18203/2320-1770.ijrcog20253875

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Original Research Articles