Skip to main content Accessibility help
×
Home

Risk Factors for Surgical-Site Infections Following Cesarean Section

  • Carol A. Killian (a1), Eileen M. Graffunder (a1), Timothy J. Vinciguerra (a1) and Richard A. Venezia (a1)

Abstract

Objective:

To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.

Design:

Prospective cohort study.

Setting:

High-risk obstetrics and neonatal tertiary-care center in upstate New York.

Patients:

Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.

Methods:

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 read-mission to the hospital or by a postdischarge survey.

Results:

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 (F=02), whether or not active labor or ruptured membranes were present.

Conclusion:

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.

Copyright

Corresponding author

Infection Control Practitioner, Department of Epidemiology, Albany Medical Center, New Scotland Ave, Albany, NY 12208

References

Hide All
1. Kreutner, A, Del-Bene, V, Delamar, D, Bodden, J, Loadholt, C. Perioperative cephalosporin prophylaxis in cesarean section: effects on endometritis in the high risk patient. Am J Obstei Gynecol 1979;134:925935.
2. Centers for Disease Control and Prevention. Rates of cesarean delivery-United States. MMWR 1993;44:303307.
3. Centers for Disease Control and Prevention. CDC National Vital Statistic Reports Births. Final Data for 1997. 1997;47(18).
4. Hemsell, D. Prophylactic antibiotics in gynecologic and obstetric surgery. Rev Infect Dis 1991;13(suppl 110):S821S841.
5. Cunningham, F, Hauth, J, Strong, J, Kappus, S. Infectious morbidity following cesarean section. Obstet Gynecol 1978;52:656661.
6. Gibbs, R, Blanco, J, St Clair, P. A case control study of wound abscess after cesarean delivery. Obstet Gynecol 1983;62:498501.
7. Emmons, S, Krohn, M, Jackson, M, Eschenbach, D. Development of wound infections among women undergoing cesarean section. Obstet Gynecol 1988;72:559564.
8. Faro, S. Antibiotic prophylaxis. Obstet Gynecol Clin North Am 1989;16:279289.
9. Gibbs, R. Infection after cesarean section. Clin Obstet Gynecol 1988;28:697.
10. Beatti, P, Rings, T, Hunter, M, Lake, Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol 1994;34:398402.
11. Casey, B, Cox, S. Chorioamnionitis and endometritis. Infect Dis Clin North Am 1997;11:203222.
12. Hirsch, HA. Prophylactic antibiotics in obstetrics and gynecology. Am J Med 1985;8(6B):S170S176.
13. Pirwany, I, Mahmood, T. Audit of infective morbidity following cesarean section at a district general hospital. J Obstet Gynecol 1997;17:439443.
14. Appuzio, JJ, Reyelt, C, Pelosi, M, Sen, P, Louria, DB. Prophylactic antibiotics for cesarean section: comparison of high- and low-risk patients for endomyometritis. Obstet Gynecol 1982;59:693698.
15. Duff, P, Smith, P, Keiser, J. Antibiotic prophylaxis in low risk cesarean section. J Repro Med 1982;27:133138.
16. Ehrenkranz, N, Blackwelder, W, Pfaff, S, Poppe, D, Yerge, D, Kaslow, R. Infections complicating low-risk cesarean sections in community hospitals: efficacy of antimicrobial prophylaxis. J Obstet Gynecol 1990;162:337343.
17. Classen, D, Evans, R, Pestotnik, S, Horn, S, Menlove, R, Burke, J. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med 1992;326:281286.
18. Gordon, H, Phelps, D, Blanchard, K. Prophylactic cesarean section antibiotics: maternal and neonatal morbidity before and after cord clamping. Obstet Gynecol 1979;53:151156.
19. Cunningham, G, Leveno, K, DePalma, R, Roark, M, Rosenfield, C. Perioperative antimicrobials for cesarean delivery: before or after cord clamping? Obstet Gynecol 1983;62:151154.
20. Guidelines for Prenatal Care. 4th ed, revised. Elk Grove, IL: American Academy of Pediatrics and College of Obstetricians and Gynecologists; 1997.
21. Abramowicz, M. Antimicrobial prophylaxis in surgery. Med Lett 1999;41:7579.
22. ASHP Commission on Therapeutics. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Clin Pharm 1992;11:483513.
23. Page, C, Bohnen, J, Fletcher, J, McManus, A, Solomkin, J, Wittmann, D. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:7988.
24. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance System Manual. Atlanta, GA: CDC; 1994.
25. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guidelines for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;20:247280.
26. Gravel-Tropper, D. Underestimation of surgical site infection rates in obstetrics and gynecology. Am J Infect Control 1995;23:2226.
27. Horan, T, Culver, D, Gaynes, R. Results of a multicenter study on risk factors for surgical site infections following c-section. Am J Infect Control 1996;24:84. Abstract.
28. Mugford, M, Kingston, J, Chalmers, I. Reducing the incidence of infection after cesarean section: implications of prophylaxis with antibiotics for hospital resources. BMJ 1989;299:10031006.
29. Duff, P. Prophylactic antibiotics for cesarean delivery: a simple cost-effective strategy for prevention of postoperative morbidity. Am J Obstet Gynecol 1987;157:794798.

Risk Factors for Surgical-Site Infections Following Cesarean Section

  • Carol A. Killian (a1), Eileen M. Graffunder (a1), Timothy J. Vinciguerra (a1) and Richard A. Venezia (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed