POST-CAESAREAN WOUND INFECTIONS: INCIDENCE, BACTERIAL PROFILE, ANTIMICROBIAL SUSCEPTIBILITY PATTERNS AND ASSOCIATED FACTORS IN PUBLIC HOSPITALS, SOUTHERN ETHIOPIA

Abstract

Background: Post-caesarean wound infections are a maternal health concern associated with increased morbidity and extended hospital stays, mainly when caused by drug-resistant pathogens. Nevertheless, the cases of Caesarean section are increasing worldwide, and post-caesarean wound infections are usually underestimated in developing countries, including Ethiopia. Objectives: To determine the incidence rate of post-caesarean wound infections,bacteriological profile, antimicrobial susceptibility patterns, and associated factors among women who are suspected of post-caesarean wound infections attending three public hospitals (Arba Minch General Hospital, Wolaita Sodo University Teaching Hospital, and Gidole Hospital), southern Ethiopia from 1st February to 31st July 2021. Methods: A prospective cross-sectional study was undertaken in three public hospitals (Arba Minch General Hospital: 478, Wolaita Sodo University Teaching Hospital: 966, and Gidole Primary Hospital: 211 with a total of 1655 pregnant women who had undergone CS. All women were followed up for 30 days, and those who developed a clinically infected wound (i.e., 204) were included in the bacteriological analysis by convenient sampling technique. A pre-tested questionnaire was used to collect the demographic, maternal, and clinical data. Wound samples were collected to identify bacteria as per the microbiological guidelines. Antimicrobial susceptibility profiles were determined by the Kirby–Bauer disk diffusion method. Extended-spectrum beta lactamase and carbapenemase enzyme producers were tested by double disk diffusion and modified carbapenem inhibition methods, respectively. Data were analyzed using SPSS version 25. P-value ≤ 0.05, 95% confidence intervals, and odds ratios were used to determine the presence and strength of the association. Results: The overall incidence of post-caesarean wound infection was 12.32%; 204/1655 (95% CI: 10.7, 13.9). Of the 204 wound samples, 85.78% (175/204) were aerobic culture-positive, yielding 203 bacterial isolates. Gram-negative and Gram-positive bacterial isolates were detected in 57.8 and 41.7%, respectively. Wound infections were predominantly caused by Staphylococcus aureus (n=65, 32.01%), followed by Klebsiella pneumoniae (n=54, 26.6%). Gram-negative isolates were highly resistant to piperacillin, ceftriaxone, cefotaxime, and co-trimoxazole (>85%), whereas Gram-positive isolates were highly resistant to penicillin and tetracycline (>90%). Overall, 70.44% (n=143) of isolates were multidrug-resistant. Methicillin-resistant Staphylococcus aureus, MR-coagulase-negativeStaphylococcus and vancomycin-resistant Enterococci respectively were 47.7 (n=31), 41.2 (n=7) and 66.7% (n=2). Overall, 23.8% (n=20) of Enterobacteriaceae were ESBL producers. Furthermore, 5.95% (n=5) of Enterobacteriaceae were carbapenem-resistant. Parity [P=0.01, AOR: 4.4, (CI: 1.40, 13.87)], previous CS [P=0.0, AOR: 6.3, (CI: 3.10, 13.01)], diabetes mellitus [P=0.05, AOR: 3.2, (CI: 2.1, 5.8)], and emergency CS [P= 0.05, AOR: 2.07, (CI: 1.06, 2.63)] were significantly associated with post-caesarean wound infections. Conclusions: Overall results of our study revealed that the incidence of post-caesarean wound infections was relatively high in our study and multi-drug resistance among bacterial isolates (MRSA, VRE, CRE, and ESBL) are increasing at an alarming rate, posing a tremendous maternal health concern. Hospital infection prevention and control strategies aimed to address clinical and surgical procedural factors linked to infections can help reduce the problem in the study area.