Dessu Samuel, Samuel Serawit, Gebremeskel Feleke, Basazin Alemu, Tariku Zerihun, Markos Meles
Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
Department of Public Health, College of Medicine and Health Sciences, Wolaita Soddo University, Soddo, Ethiopia.
PLoS One. 2021 Apr 16;16(4):e0250174. doi: 10.1371/journal.pone.0250174. eCollection 2021.
Post cesarean section surgical site infection increases both the duration of a patient's hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities.
Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers' who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model.
Age 20-34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection.
Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.
剖宫产术后手术部位感染会增加患者的住院时间和意外住院费用。它会延迟康复、延长住院时间、需要再次入院，并增加医院账单以及其他发病率和死亡率。
2019年3月1日至4月20日，在迪雷达瓦行政区公立医院对2018年1月1日至12月31日登记的所有母亲记录进行了基于机构的病例对照研究。通过普查提取了剖宫产术后手术部位感染母亲（119例）的记录，对于每个病例，由经过培训的数据收集人员使用结构化数据提取工具收集每三个连续的对照（357例）。在双变量分析中p值<0.25的变量被视为多变量分析的候选变量。在多变量逻辑回归模型中，当P值≤0.05且调整后的比值比和95%置信区间时声明具有统计学意义。
年龄20 - 34岁（调整后的比值比：5.4；95%置信区间：2.35,12.7）、年龄>35岁（调整后的比值比：8.9；95%置信区间：1.8,43.9）、阴道检查≥4次（调整后的比值比：4.2；95%置信区间：2.16,8.22）、当前绒毛膜羊膜炎病史（调整后的比值比：5；95%置信区间：1.05,23.9）、既往剖宫产史（调整后的比值比：6.2；95%置信区间：2.72,14.36）、预防性使用抗生素（调整后的比值比：3.2；95%置信区间：1.81,5.62）、围手术期血细胞比容水平<30%（调整后的比值比：6.9；95%置信区间：3.45,14.1）以及胎膜破裂持续时间>12小时（调整后的比值比：5.4；95%置信区间：1.84,15.87）是剖宫产术后手术部位感染的独立决定因素。
在多变量分析中，母亲年龄增加、阴道检查次数增多、有绒毛膜羊膜炎病史、有既往剖宫产史、未接受抗生素预防、围手术期血细胞比容水平较低以及胎膜破裂持续时间较长具有统计学意义。因此；应重点关注年龄较大、有剖宫产瘢痕和绒毛膜羊膜炎病史的母亲。此外；对于所有接受剖宫产的母亲应全面提供抗生素。
