Risk factors for surgical site infections following Caesarean section: findings from a comprehensive Victorian surveillance program (2003-2015)

Anna Baldes 1, Sandra Johnson 1, Leon J Worth 1,2, Ann Bull 1, Tim Spelman 1, Judith Brett 1Michael J Richards 1

VICNISS Coordinating Centre, Melbourne, VIC, Australia

University of Melbourne, Melbourne, VIC, Australia


Surgical site infections (SSI) are the most common complication of Caesarean sections (CS), contributing significantly to adverse outcomes and increased healthcare costs. Patient, obstetric and surgical factors have been associated with increased risk. This study analysed data from 82367 CS to determine which factors, including antibiotic prophylaxis practices, are associated with increased risk in Australia.

Data collated by the Victorian Healthcare Associated Infection Surveillance System (VICNISS) between 2003 and 2015 were analysed. The VICNISS framework, based on the US CDC NHSN methodology, prospectively captures data on CS conducted in participating Victorian centres. Appropriateness of antibiotic prophylaxis was assessed according to the Australian Therapeutic Guidelines (TG) for Antibiotics.
Descriptive analyses were conducted. A multivariable Poisson regression model was applied.

Overall, 1032 (1.25%) SSI were identified during admission or on readmission. Factors independently associated with increased SSI risk in the multivariable model included: younger age (<24 years); increasing WHO BMI category, labour, primary CS, increasing ASA score, increasing procedure duration, emergency procedures and no prophylactic antibiotics.
A total of 39906 procedures between 2011 and 2015 included detailed data on antibiotic prophylaxis. Antibiotic agent and timing aligned with TG in 91.5% and 41.3% of procedures, respectively.

This large study identified multiple independently associated risk factors for SSI post-CS. Key modifiable factors included procedure duration and administration of prophylactic antibiotics. Future development of an infection control bundle should incorporate these factors, particularly given the suboptimal uptake of TG recommendations.

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