Microbiological profile and clinical correlates of post-cesarean surgical site infections

To characterize the microbiological profile of post-cesarean surgical site infection (SSI) wound cultures, examine associations between specific pathogens and clinical or surgical characteristics, and delineate institutional wound culture collection practices.

A retrospective cohort study including women with positive wound cultures from clinically diagnosed post-cesarean SSIs between 2012 and 2024. Microorganisms were categorized into designated pathogen groups based on taxonomic classification and clinical relevance. Each microorganism group was compared with all remaining cases. Demographic, obstetric, surgical, laboratory, and outcome variables were analyzed using appropriate univariate statistical tests.

A total of 207 positive wound cultures were analyzed. The most frequently isolated organisms were Enterobacterales (30.4 %), Staphylococcus aureus and β-hemolytic streptococci (27.1 %), and coagulase-negative staphylococci (20.3 %). Enterobacterales infections were significantly associated with obesity (BMI >35), meconium-stained amniotic fluid, and longer intervals from rupture of membranes to labor onset. Non-fermenting Gram-negative organisms were strongly associated with subcutaneous tissue approximation and intradermal skin closure. Coagulase-negative staphylococci were associated with fewer established risk factors, suggesting possible contamination or colonization. Only Enterobacterales infections demonstrated a statistically significant, though clinically modest, increase in peak white blood cell count. No significant differences were observed in other severity markers or clinical outcomes.

Routine wound cultures in post-cesarean SSIs provide limited information regarding disease severity. However, specific pathogen profiles are associated with distinct obstetric and surgical characteristics, suggesting that selective culture use may be informative in high-risk clinical contexts. These findings may help improve institutional wound-culture practices and inform future studies on culture-guided management strategies.