Factors associated with superficial surgical site infection after emergency cesarean section at Befelatanana University Hospital, Madagascar: a retrospective case-control study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261872Keywords:
Cesarean section, Emergency obstetric surgery, Madagascar, Risk factors, Superficial incisional infection, Surgical site infectionAbstract
Background: Surgical site infection (SSI) after emergency cesarean section is a preventable cause of maternal morbidity and additional cost, especially in resource-limited maternity hospitals. This study aimed to identify factors associated with superficial incisional SSI after emergency cesarean section at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar.
Methods: A retrospective case-control study was conducted from January 2020 to December 2021. Cases were women treated for superficial incisional SSI within 30 days after emergency cesarean section at term. Controls were women without SSI, selected at a ratio of two controls per case. Data were extracted from hospital records, antenatal cards, registers and interviews. Odds ratios (ORs), 95% confidence intervals (CIs) and p values were calculated.
Results: Among 12,708 deliveries, 4,857 were cesarean sections, including 3,897 emergency procedures. Sixty superficial SSIs were identified, giving a frequency of 1.5%; 120 controls were included. Factors significantly associated with SSI were age ≥35 years, absence of antenatal care, BMI ≥25 kg/m2, premature rupture of membranes, membrane rupture ≥12 hours, labour ≥12 hours, operation duration ≥60 minutes, blood loss ≥1000 ml and operation by a specialist trainee.
Conclusions: Superficial SSI after emergency cesarean section was multifactorial. Strengthening antenatal care, timely labour management, optimized antibiotic prophylaxis, senior supervision, infection-prevention bundles and post-discharge wound surveillance may reduce post-cesarean SSI in this setting.
References
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):250-78.
World Health Organization. Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization; 2016.
Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of cesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6:e005671.
Farid Mojtahedi M, Sepidarkish M, Almukhtar M, Eslami Y, Mohammadianamiri F, Behzad Moghadam K, et al. Global incidence of surgical site infections following cesarean section: a systematic review and meta-analysis. J Hosp Infect. 2023;139:82-92.
Baklola M, Terra M, Elsehrawy MG, Alali H, Aljohani SS, Alomireeni AA, et al. Epidemiology of surgical site infections post-cesarean section in Africa: a comprehensive systematic review and meta-analysis. BMC Pregnancy Childbirth. 2025;25:465.
Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014;(10):CD007482.
American College of Obstetricians and Gynecologists. Use of prophylactic antibiotics in labor and delivery. ACOG Practice Bulletin No. 199. Obstet Gynecol. 2018;132:e103-19.
National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. London: NICE; 2019, updated 2020.
Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following cesarean section in England: results from a multicentre cohort study. BJOG. 2012;119(11):1324-33.
Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84.
Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following cesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014;3:25.
Dessu S, Samuel S, Gebremeskel F, Basazin A, Tariku Z, Markos M. Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: case-control study. PLoS One. 2021;16(4):e0250174.
Gomaa K, Abdelraheim AR, El Gelany S, Khalifa EM, Yousef AM, Hassan H. Incidence, risk factors and management of post cesarean section surgical site infection in a tertiary hospital in Egypt: a five-year retrospective study. BMC Pregnancy Childbirth. 2021;21:634.
Omara S, Kasujja M, Okot G, Okello P, Okello M, Mulumba R, et al. Predictors of post-cesarean surgical site infections at Mubende Regional Referral Hospital, Central Uganda: prospective cohort study. Int J Womens Health. 2024;16:1939-45.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016.
Zuarez-Easton S, Zafran N, Garmi G, Salim R. Post cesarean wound infection: prevalence, impact, prevention, and management challenges. Int J Womens Health. 2017;9:81-8.
Tita ATN, Szychowski JM, Boggess K, Saade G, Longo S, Clark E, et al. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2016;375:1231-41.
Ali N, Neway S, Desta K. Post-cesarean section infection burden, antimicrobial resistance pattern, and associated factors at All Africa Leprosy Rehabilitation and Training Center Comprehensive Specialized Hospital, Addis Ababa, Ethiopia. PLoS One. 2025;20(7):e0326935.
Conroy K, Koenig AF, Yu YH, Courtney A, Lee HJ, Norwitz ER. Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Rev Obstet Gynecol. 2012;5(2):69-77.
Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-303.
Berrios-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.
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