title: Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons.
abstract: Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive.
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ferraro
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.
authors.forename: Pierluca
authors.initials: P
authors.lastname: Piselli
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pittalis
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.
authors.forename: Luca E
authors.initials: LE
authors.lastname: Ruscitti
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cimaglia
authors.affiliation: National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.affiliation: Epidemiology Department, National Institute for Infectious Diseases "Lazzaro Spallanzani" Rome, Italy.|Centro di Riferimento per le Infezioni associate alle Pratiche Assistenziali Latium Region Gro.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Puro
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D010351:Patient Discharge; D011159:Population Surveillance; D011247:Pregnancy; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Caesarean section; Post-discharge surveillance; Surgical site infection