Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
BMC Infect Dis. 2020 Nov 30;20(1):902. doi: 10.1186/s12879-020-05640-0.
Following delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia.
A prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association.
The mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study.
This study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.
在剖宫产术后，手术部位感染是最常见的感染性并发症。尽管 Debre Markos 转诊医院进行了大量的剖宫产手术，但没有研究记录剖宫产术后手术部位感染的发生率。因此，本研究旨在估计在埃塞俄比亚西北部阿姆哈拉地区的 Debre-Markos 转诊医院行剖宫产术后手术部位感染的发生率。
本研究为前瞻性队列研究，纳入 2019 年 3 月 28 日至 2019 年 8 月 31 日期间行剖宫产术的 520 名孕妇。使用标准化问卷收集术前、术中、术后数据。数据使用 EpiData™Entry Version 4.1 软件录入，使用 R Version 3.6.1 软件进行分析。使用表格、四分位距和中位数进行描述性分析。使用 Kaplan-Meier 方法估计手术部位感染的发生时间。使用二变量和多变量 Cox 回归模型进行分析。报告调整后的危害比（AHR）及其 95%置信区间（CI）以显示关联的强度。
本研究队列的平均年龄为 27.4±4.8 岁。手术部位感染的总累积发生率为 25.4%，每 1000 人/天的发生率为 11.7（95%CI：9.8，13.9）。不能读写（AHR=1.30，95%CI：1.19，2.11）、无产前检查（AHR=2.16，95%CI：1.05，4.53）、有剖宫产史（AHR=1.21，95%CI：1.11，2.31）、HIV 阳性（AHR=1.39，95%CI：1.21，2.57）、急诊手术（AHR=1.13，95%CI：1.11，2.43）、垂直切口类型（AHR=2.60，95%CI：1.05，6.44）、胎膜早破（AHR=1.50，95%CI：1.31，1.64）、多次阴道检查（AHR=1.88，95%CI：1.71，3.20）是本研究中手术部位感染的显著预测因素。
本研究得出的结论是，与之前的研究相比，剖宫产术后手术部位感染的发生率相对较高。不能读写、无产前检查、有剖宫产史、HIV、急诊手术、垂直切口类型、剖宫产术前胎膜早破、多次阴道检查是本研究中手术部位感染的显著预测因素。因此，干预计划应重点关注并解决已确定的因素，以尽量减少和预防剖宫产术后的感染率。
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