title: Risk factors for cesarean surgical site infections at a Thai-Myanmar border hospital.
abstract: Cesarean surgical site infections (SSIs) are a major challenge in Thai-Myanmar border hospital settings. This study aimed to examine risk factors for SSIs after cesarean section.
  
  
  
  This was a prospective cohort study conducted in a Thai-Myanmar border hospital between January 2007 and December 2012. Data were collected from the medical record database by trained infection control nurses. Stepwise multivariable logistic regression was used for risk factor analysis and expressed as a risk ratio (RR).
  
  
  
  The cesarean SSI rate was 5.9% (293 SSIs in 4,988 cases). Of these, 17.1% were incisional SSIs (10.9% superficial and 6.2% deep incisional SSIs), and 82.9% were organ or space SSIs. Risk factors for cesarean organ-space SSIs included a wound class ≥3 (RR, 4.82; 95% confidence interval [CI], 3.41-6.83), ethnic minority (RR, 2.51; 95% CI, 1.61-3.92), hemoglobin <11 g/dL (RR, 2.19; 95% CI, 1.57-3.04), pelvic examination before delivery on ≥5 occasions (RR, 4.16; 95% CI, 2.89-5.99), preterm (RR, 1.98; 95% CI, 1.33-2.95), being a local referral (RR, 3.37; 95% CI, 2.29-4.97), and foul-smelling amniotic fluid (RR, 21.08; 95% CI, 10.23-43.41).
  
  
  
  Most cesarean SSIs in this study seem to have a high severity. Their risk factors reflected delayed appropriate perinatal maternal care that resulted in late cesarean delivery. Early prenatal care may help reduce cesarean SSIs among this population.
authors.affiliation: Infection Control Section, Maesot Hospital, Tak, Thailand.
authors.forename: Srisuda
authors.initials: S
authors.lastname: Assawapalanggool
authors.affiliation: Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. Electronic address: nongyaok2003@gmail.com.
authors.forename: Nongyao
authors.initials: N
authors.lastname: Kasatpibal
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Supatra
authors.initials: S
authors.lastname: Sirichotiyakul
authors.affiliation: Department of Obstetrics and Gynecology, Lampang Hospital, Lampang, Thailand; Collaborative Project to Increase Rural Doctors, Ministry of Public Health, Thailand.
authors.forename: Rajin
authors.initials: R
authors.lastname: Arora
authors.affiliation: Department of Obstetrics and Gynecology, Nakornping Hospital, Chiang Mai, Thailand.
authors.forename: Watcharin
authors.initials: W
authors.lastname: Suntornlimsiri
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006761:Hospitals; D006801:Humans; D002052:Myanmar; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013785:Thailand; D055815:Young Adult
keywords: Risk factors; caesarean infections; caesarean section; cohort study; surgical site infections