Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-30T20:19:46.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

Published online by Cambridge University Press:  02 January 2015

Margaret A. Olsen ,
Anne M. Butler ,
Denise M. Willers ,
Preetishma Devkota ,
Gilad A. Gross  and
Victoria J. Fraser
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Anne M. Butler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Denise M. Willers
Affiliation:
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
Preetishma Devkota
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Gilad A. Gross
Affiliation:
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Campus Box 8051, 660 S. Euclid, St. Louis, MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.

Objective.

To determine independent risk factors for SSI after low transverse cesarean section.

Design.

Retrospective case-control study.

Setting.

Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.

Patients.

A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.

Methods.

Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.

Results.

SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.

Conclusions.

These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 477 - 484
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cooper, NJ, Sutton, AJ, Abrams, KR. Decision analytical economic modelling within a Bayesian framework: application to prophylactic antibiotics use for caesarean section. Stat Methods Med Res 2002;11:491–512.Google Scholar
2.Chaim, W, Bashiri, A, Bar-David, J, Shoham-Vardi, I, Mazor, M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000;8:77–82.Google Scholar
3.Killian, CA, Graffunder, EM, Vinciguerra, TJ, Venezia, RA. Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol 2001;22:613–617.Google Scholar
4.Lasley, DS, Eblen, A, Yancey, MK, Duff, P. The effect of placental removal method on the incidence of postcesarean infections. Am J Obstet Gynecol 1997;176:1250–1254.Google Scholar
5.Mitt, P, Lang, K, Peri, A, Maimets, M. Surgical-site infections following cesarean section in an Estonian university hospital: postdischarge surveillance and analysis of risk factors. Infect Control Hosp Epidemiol 2005;26:449–454.CrossRefGoogle Scholar
6.Myles, TD, Gooch, J, Santolaya, J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 2002;100(5 Pt 1):959–964.Google Scholar
7.Schneid-Kofman, N, Sheiner, E, Levy, A, Holcberg, G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet 2005;90:10–15.CrossRefGoogle ScholarPubMed
8.Tran, TS, Jamulitrat, S, Chongsuvivatwong, V, Geater, A. Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95:367–371.Google ScholarPubMed
9.Vermillion, ST, Lamoutte, C, Soper, DE, Verdeja, A. Wound infection after cesarean: effect of subcutaneous tissue thickness. Obstet Gynecol 2000;95(6 Ptl):923–926.Google Scholar
10.Yokoe, DS, Christiansen, CL, Johnson, R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001;7:837–841.CrossRefGoogle ScholarPubMed
11.Yokoe, DS, Noskin, GA, Cunningham, SM, et al. Enhanced identification of postoperative infections. Emerg Infect Dis 2004;10:1924–1930.Google Scholar
12.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
13.DeFrances, CJ, Hall, MJ. 2005 National Hospital Discharge Survey. Adv Data 2007;385:1–19.Google Scholar
14.Incerpi, MH. Operative delivery. In: DeCherney, AH, Nathan, L, Goodwin, TM, Laufer, N, eds. Current Diagnosis and Treatment: Obstetrics and Gynecology. New York: McGraw-Hill Medical Publishing Division; 2007:461–476.Google Scholar
15.Hirschhorn, LR, Currier, JS, Piatt, R. Electronic surveillance of antibiotic exposure and coded discharge diagnoses as indicators of postoperative infection and other quality assurance measures. Infect Control Hosp Epidemiol 1993;14:21–28.Google Scholar
16.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippin-cott Williams & Wilkins; 2004:1659–1702.Google Scholar
17.Royston, P, Ambler, G, Sauerbrei, W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 1999;28:964–974.Google Scholar
18.Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention (published correction appears in MMWR Morb Mortal Wkly Rep 1996;45:679). MMWR Recomm Rep 1996;45(RR-7):1–24.Google Scholar
19.Johnson, A, Young, D, Reilly, J. Caesarean section surgical site infection surveillance. J Hosp Infect 2006;64:30–35.Google Scholar
20.Miller, PJ, Searcy, MA, Kaiser, DL, Wenzel, RP. The relationship between surgeon experience and endometritis after cesarean section. Surg Gynecol Obstet 1987;165:535–539.Google ScholarPubMed
21.Lau, WY, Fan, ST, Chu, KW, Yip, WC, Yuen, WC, Wong, KK. Influence of surgeons' experience on postoperative sepsis. Am J Surg 1988;155:322–326.Google Scholar
22.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
23.Alexander, JK, Dennis, EW, Smith, WG, Amad, KH, Duncan, WC, Austin, RC. Blood volume, cardiac output, and distribution of systemic blood flow in extreme obesity. Cardiovasc Res Cent Bull 1962;1:39–44.Google ScholarPubMed
24.Nystrom, PO, Jonstam, A, Hojer, H, Ling, L. Incisional infection after colorectal surgery in obese patients. Acta Chir Scand 1987;153:225–227.Google Scholar
25.Roy, M-C. Modern approaches to preventing surgical site infections. In: Wenzel, , ed. Prevention and Control of Nosocomial Infections. Philadelphia: Lippincott Williams & Wilkins; 2003:370–384.Google Scholar
26.Lazar, HL, Chipkin, SR, Fitzgerald, CA, Bao, Y, Cabral, H, Apstein, CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation 2004;109:1497–1502.Google Scholar
27.Trick, WE, Scheckler, WE, Tokars, JI, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2000;119:108–114.Google Scholar
28.Zerr, KJ, Furnary, AP, Grunkemeier, GL, Bookin, S, Kanhere, V, Starr, A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997;63:356–361.CrossRefGoogle ScholarPubMed
29.Furnary, AP, Zerr, KJ, Grunkemeier, GL, Starr, A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67:352–360.Google Scholar
30.Smaill, F, Hofmeyr, GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002;(3):CD000933.Google Scholar
31.ACOG practice bulletin number 47, October 2003: Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol 2003;102:875–882.Google Scholar
32.Sanni, A, Dunning, J. Staples or sutures for chest and leg wounds following cardiovascular surgery. Interact Cardiovasc Thorac Surg 2007;6:243–246.Google Scholar
33.Kluytmans, J. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore: Williams & Wilkins; 1997:841–865.Google Scholar
34.Beckman, C, Ling, F, Smith, R, Barzansky, B, Herbert, W, Laube, D. Postpartum infection. In: Beckman, C, edr. Obstetrics and Gynecology. Philadelphia: Lippincott Williams & Wilkins; 2006:146–52.Google Scholar
35.Edlich, RF, Rodeheaver, GT, Thacker, JG. Technical factors in the prevention of wound infections. In: Howard, RJ, Simmons, RL, eds. Surgical Infectious Diseases. Norwalk, CT: Appleton & Lange; 1995:423–463.Google Scholar