ABSTRACT
Background: Delivery by caesarean section has been reported as the single most important risk factor for maternal wound infection. Wound infection is not only a leading cause of prolonged hospital stay but a major cause of widespread aversion to caesarean delivery in developing countries. Despite all these, the determinants of post-caesarean wound infection in Nnewi have remained largely uninvestigated. Objective: This study was to determine the factors that predispose to post- caesarean wound infection at a tertiary institution in a developing country. Design: This was a cross sectional study. Place and Duration of Study: Labour ward, Theatre and Post natal ward of NAUTH Nnewi between April to November 2012. Methodology: All women who had caesarean section, met the inclusion criteria and gave consent were included in the study. They were divided into two groups (Group A and Group B) each comprising 60 women. Group A comprised women who had emergency caesarean section, while those in group B had elective caesarean section. The outcome of their post-caesarean wound was assessed. Statistical analysis (Logistic regression) of identified risk factors in patients who developed wound infection was performed at a 95% confidence interval. Results: The incidence of post caesarean wound infection was 12.5%. While the infection rate was twelve (20.0%) among women who had emergency caesarean section, it was 3 (5.0%) among those who had elective caesarean section. The identified independent risk factors for wound infections were the duration of membrane rupture more than 24 hours (OR=0.11: 95% CI 0.03- 0.47: P =0.003), labour duration more than 12 hours (OR =0.07: 95% CI 0.01-0.32: P =0.001) and the use of subumbilical, midline incision (OR=0.21: 95% CI 0.05-0.91). Conclusion: The post caesarean wound infection rate in NAUTH was high. Efforts should be geared towards the prevention of prolonged labour by health education, early intervention and use of partograph. Timely intervention for prolonged rupture of membranes would drastically reduce the incidence of wound infection in our area.
ABSTRACT
Background: Urinary tract catheterization is a major risk factor for urinary tract infections (UTIs). Catheter associated urinary tract infections (CAUTIs) still remain a major reservoir of antibiotic resistant pathogens with attendant increase in morbidity and mortality. Objective: To determine and compare the incidence of catheter associated urinary tract infections following immediate and 24-hour postoperative removal of urethral catheters for caesarean section. Design: The study was a prospective, comparative study. Place and Duration of Study: Labour ward, Theatre and Postnatal wards of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi between August 2012 to April 2013. Methodology: The study involved 156 women admitted for caesarean section where the urethral catheters were removed 24-hour post operatively (group A) or immediately after caesarean section (group B). Urine samples were collected. Outcome measures included pre-operative and 72 hour postoperative urine microscopy, culture and sensitivity, urinary frequency, dysuria, urgency, fever and duration of hospital stay. The patients’ data were coded, computed and analyzed using SPSS version 16. A P-value of <0.05 was considered significant. Results: Of the 79 patients in group A, 9 (11.4%) had significant bacteriuria in the 72 hour post operative urine culture while 5 (6.5%) had significant bacteriuria in group B, (OR=1.85: 95% CI 0.59-5.80, P=0.28). The overall incidence of catheter associated urinary tract infection in NAUTH was 14(9.0%). Escherichia coli were mostly isolated 4 (44.4%). The lowest level of resistance was seen with Amoxycillin- clavulanic acid (Augmentin). Conclusion: The present study showed that significant bacteriuria in Group A almost double the incidence in Group B, however, the difference was not statistically significant. Further studies should be carried out to compare catheterization with non- catheterization for caesarean section.