study of post-caesarean section wound infections in a regional referral hospital, Oman

The aim of this study was to determine the incidence of surgical site infections [SSI] in patients undergoing a Caesarean section [CS] and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patients quality of life by increasing morbidity and extending hospital stays. A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean [PCS] SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSL Controls [220] were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSL Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. The total number of PCS wound infections was 211 [2.66%]. There was a four-fold higher incidence of premature rupture of the membranes [37, 17.53%] and a three-fold higher incidence of diabetes [32, 15.16%] in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus [66, 31.27%] and the Gram-negative Escherichia coli group [40, 18.95%]. The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 [19.90%], while 47 [22.27%] yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques

Methotrexate treatment of ectopic pregnancy: experience at Nizwa hospital with literature review

Ectopic pregnancy occurs when the embryo fails to implant within the uterine cavity. Methotrexate, a folic acid antagonist has been widely used to treat ectopic pregnancy. The aim of this study is to determine the efficacy of methotrexate treatment for ectopic pregnancies in our settings which will in-turn help us reduce maternal mortality and morbidity. This was a retrospective review of 60 cases of ectopic pregnancy treated with single dose methotrexate in Nizwa hospital, Oman. Demographic data, clinical presentation, treatment progress, outcome, side effects and future fertility follow up were analysed using a computer database. Selection criteria included hemodynamically stable women with beta-hcg level of

Risk factors for postcaesarean surgical site infection

To identify the risk factors associated with surgical site infections [SSI] after cesarean section [CS]. Descriptive study. Maternal and Child Health Centre [MCH], Pakistan Institute of Medical Sciences [PIMS], Islamabad. From January 2003 to June 2004. All post cesarean patients in postnatal ward with surgical site purulent discharge as well as patients readmitted on postoperative follow up in Outpatient department with SSI Patients with SSI after gynecological surgery were excluded Main outcome measures were association of SSI with preexisting maternal and intrapartum factors, level of surgeon, causative organisms and their sensitivity and postoperative hospital stay. There were 841 cesarean sections done during study period SSI occurred in 34 [4.0%] patients. Frequency of SSI after elective cesarean sections was 1.7% and after emergency CS was 4.8%. The associated risk factors were anemia [13 cases] i.e 38.2%, dai handling in 4[11.8%] cases, prolonged ruptured membranes in 9[26.5%], prolonged labour in 5[14.7%] and diabetes 3[8.8%] cases. The category distribution of surgeons in such cases was found to be consultant in 2[6%], senior registrar in 2[6%], third year resident in 10[32%], second year resident in 14[41%], first year resident in 6[17.6%]. The organisms isolated on wound swab cultures were Staphylococcus aureus 8[23.5%], Pseudomonas 3[8.8%], E-coli 2[6%], Klebseilla 2[6%], Proteus 1[3%] and no organism was isolated in 18[53%] cases. The antibiotics given after culture and sensitivity report were Quinolone 8[23.5%] and first and third generation Cephalosporin in 17[50%] cases. The mean length of post operative stay of SSI cases was 17.8 +/- 7.8 days. The frequency of surgical site infection was more in emergency cesarean sections. Anemia and prolonged Prelabour Rupture of Membranes [PROM] were frequently associated factors in SSI after the operation