Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study.
OBJECTIVE
The aim of this study was to document the true incidence of post-cesarean surgical site infections (SSI), according to the definition of the US Centers for Disease Control and Prevention (CDC), and to identify independent risk factors for infection.


METHODS
Prospective population-based cohort study in Norway. Setting. Sykehuset Asker og Baerum HF, a secondary community hospital, associated with the University of Oslo (UiO), Norway, accounting for 2,000 deliveries per year. Participants. All cesarean deliveries during a 12-month period from September 2003. Main outcome measures. Rate and risk factors for SSI.


RESULTS
The total rate of SSI was 8.9%, with an observation period of 30 days post-operatively, compared to 1.8% registered at hospital discharge. The total response rate was 100%. There was no significant difference in SSI rate in elective or emergency cesarean section (CS), respectively. All SSI were superficial. We found 2 significant independent risk factors: operating time > or =38 min and body mass index (BMI) >30.


CONCLUSIONS
The rate of SSI is underestimated if the observation time is limited to the hospital stay. Operating time exceeding 38 min substantially increases the risk of SSI. The finding of no significant difference in SSI rate between elective and emergency CS should lead to a different approach concerning the use of antibiotics: subgroup at risk (operating time > or =38 min and BMI >30) may benefit from antibiotics in relation to the operation, whether the CS is an emergency or elective operation.
Opøien
Hans Kristian
HK
Department of Obstetrics and Gynaecology, Asker og Baerum Sykehus, HF, Norway. hans.kristian.opoien@rikshospitalet.no
Valbø
Annelill
A
Grinde-Andersen
Anette
A
Walberg
Mette
M
D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008423:Maternal Age; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013997:Time Factors