Risk Factors for Surgical‐Site Infections Following Cesarean Section

• Published in: Infection control and hospital epidemiology Vol. 22; no. 10; pp. 613 - 617
• Main Authors: Killian, Carol A., Graffunder, Eileen M., Vinciguerra, Timothy J., Venezia, Richard A.
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ The University of Chicago Press 01-10-2001; Slack; Cambridge University Press
• Subjects: Adult; Antibiotic Prophylaxis; Antibiotics; Bacterial diseases; Bacterial diseases of the skin; Biological and medical sciences; Cesarean section; Cesarean Section - adverse effects; Childbirth; Cohort Studies; complications; Endometritis; Female; Human bacterial diseases; Humans; infection; Infections; Infectious diseases; Logistic Models; Medical sciences; New York - epidemiology; Nosocomial infection; Nursing; Obstetric labor complications; Operating rooms; Original Articles; Population Surveillance; Predisposing factors; Pregnancy; Prenatal care; Prophylaxis; Prospective Studies; Regression analysis; Risk Factors; surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; New York; Human; Surgical wound; Postoperative; Nosocomial infection; Treatment; Surgery; Risk factor; Complication; Female; Woman; Cesarean section
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/501831

To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.
Prospective cohort study.
High-risk obstetrics and neonatal tertiary-care center in upstate New York.
Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.
Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by readmission to the hospital or by a postdischarge survey.
Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95, 1.01-1.03; P=.04). Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (P=02), whether or not active labor or ruptured membranes were present.
Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.