Surgical site infections following caesarean sections in the largest teaching hospital in Ghana

Surgical site infections complicate up to 15% of all surgical procedures depending on surgery type and underlying patient status. They constitute 14-31% of all hospital-acquired infections, placing huge financial burdens on patients, healthcare institutions and the nation.

To determine the incidence, risk factors, microbiological aetiology and antibiotic susceptibility patterns of surgical-site infections following caesarean sections (CSs) at Korle Bu Teaching Hospital (KBTH), Accra, Ghana.

This prospective study involved 500 women who underwent CS from April to July 2017 at KBTH. Overall, 474 women completed the study with 26 women lost to follow-up or opting out of the study. Women were recruited on the first postoperative day and followed-up postnatally. Sociodemographic and obstetric data were obtained using a structured questionnaire. Swabs of infected surgical wounds were taken for culture and sensitivity testing using the Kirby-Bauer disk diffusion technique. Data was analysed using SPSS version 22.

Sixty-one (61/474) women (12.8%) had SSIs after CS. Of these, 41 (67.2%) were superficial, 18 (29.5%) were deep incisional and 2 (3.3%) were organ space SSIs. Significant risk factors for SSI were: emergency CS after 8 h of active labour, midline incisions, use of stored water for surgeon's pre-operative scrubbing, maternal status being single and alcohol consumption during pregnancy. Staphylococcus aureus was the commonest pathogen isolated with 6 (9.8%) being meticillin resistant (MRSA). Antibiotic susceptibility was mostly to quinolones.

SSI occurred in 12.8% of CS wounds at the KBTH, commonly caused by S. aureus.