Research from the Health Protection Agency (HPA) identified 394 surgical site infections among 4,107 women followed up after a caesarean section operation (9.6%). The majority of these infections were minor (88%) and the risk was found to be higher in overweight or obese women, according to findings published in the British Journal of Obstetrics & Gynaecology.
The study looked at data from 4,107 caesarean operations from 14 acute hospitals across England which were carried out in 2009. This rate of infection is higher than would be expected for what is considered to be a relatively ‘clean’ operation i.e. not in an area of the body with high bacterial levels such as the large bowel. Using similar methods to identify infection risk, the rate of infection following a hysterectomy is 6.6% and for operations in the large bowel it is 14.7%. Of the 394 women who developed an infection:
• 88.3% were superficial incisional infections. (These clear up in a few days but will probably require antibiotic treatment.)
• 4.8% were deep incisional surgical infections affecting deeper tissues under the skin (these will require a course of antibiotics, along with possible hospitalisation and additional surgery on the wound in more serious cases).
• 6.9% were organ/space infections, 25 of which were classed as endometritis (infection of the lining of the womb) and two were other reproductive tract infections.
• 5.8% had to be readmitted to hospital for treatment of their infection.
Obesity was associated with development of a surgical site infection, with the risk of developing an infection, whether superficial, deep or organ/space, increasing the more overweight the woman was. Those who were overweight (BMI 25-30) were 1.6 times more likely to develop an infection, obese women (BMI 30-35) were 2.4 times more likely and those with a BMI over 35, 3.7 times more likely. The research also found that younger women (those under 20, compared to those 25-30) were 1.9 times more likely to develop an infection. Reasons for this are not clear and more research is needed in this area. Dr Elizabeth Sheridan, head of healthcareassociated infections at the HPA, said: “Reducing rates of surgical site infections following a caesarean should be made a priority. Given that one in four women deliver their baby by caesarean section, these infections represent a substantial burden. They will impact not only directly on the mother and her family but also are a significant cost in terms of antibiotic use, GP time and midwife care and every effort should be made to avoid them. Women choosing to have caesarean section for non-medical reasons should be aware of the risk of infection, particularly if they are overweight. “As has been seen in both this study and several others, there is an established link between BMI and an increase in the risk of developing a surgical site infection. Monitoring infections in women having a caesarean section is important as a means to drive down infection rates. As levels of obesity are rising, optimising surgical techniques and identifying the most appropriate dosing of antibiotics could provide a means for reducing wound infections in obese women.”
Credit: www.cpf.navy.mil
