Surgical site infection and antimicrobial use following caesarean section at QECH in Blantyre, Malawi: a prospective cohort study

Abstract Background: Surgical site infections (SSIs) are the third most common healthcare-associated infections (HAIs) and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following CS at Queen Elizabeth Central Hospital (QECH). Methods: This was a hospital-based quantitative prospective study design involving pregnant women who underwent a Caesarean Section (CS) between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Some wound specimens (pus swabs) were collected from infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata. Results: The overall cumulative incidence of SSI recorded at QECH during the study period was 10% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. In contrast to the previous studies, potential risk factors including skin closure, age, parity or ANC visits were not associated with SSIs. The majority of patients with SSIs (n=12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni. All pregnant women who underwent for CS received antibiotic prophylaxis. Conclusion: The incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.