Surgical Site Infection after Caesarean Section delivery at Komfo Anokye Teaching Hospital, Kumasi, Ghana

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October, 2016.
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Surgical Site infection (SSI) is one of the health problems that are caused by the invasion of pathogenic organisms. Information on local pathogens and sensitivity to antimicrobial agents is crucial for successful treatment of wounds. Objectives: The objectives of this study was to determine the prevalence of SSI after caesarean section delivery, identify the type and frequencies of bacteria causing these infections and determine the antibiotic susceptibility pattern of pathogens involved with these infections at Komfo Anokye Teaching Hospital (KATH).A cross sectional study was conducted among women with Caesarean Section delivery at KATH, from June to December, 2015. Wound swab was collected from 40 clinically infected wounds using sterile cotton swabs and processed for bacterial isolation and susceptibility testing to antimicrobial agents following standard bacteriological techniques. Biochemical tests were done to identify the species of the organisms. Sensitivity testing was done using Kirby- Bauer disk diffusion method. Structured questionnaire were administered to harness socio demographic, surgical and antibiotic data of women. Results: The overall prevalence of SSI after Caesarean Section delivery in KATH within the study period was 9.67%. No anaerobic bacteria were isolated. The common bacteria that caused SSI after Caesarean Section at KATH was Klebsiella pneumoniae (36.25%) (n=21), followed by Pseudomonas aeruginosa (22.4%) (n=13). The least isolated bacteria were Proteus vulgaris (1.7%) (n=1) and Acinetobacter baumanii (1.7%) (n=1). Gentamicin, ciprofloxacillin and amikacin showed greater sensitivity on isolates than other antibiotics such as cefuroxime, levofloxacin and ceftriaxone. All the isolated bacteria showed high frequency of resistance to ampicillin, penicillin and tetracycline. Significant risk factors causing SSI after Caesarean Section delivery in this study was interrupted skin closure technique, emergency C/S, 2 or more vaginal examination before C/S and patient to whom antibiotic prophylaxis was not given. The prevalence rate of SSI after caesarean section delivery in this study was 9.67%, with Klebsiella pneumoniae being the most common bacteria isolate. Gentamicin, ciprofloxacin and amikacin should be used judiciously to treat wound infections. Empirical prescription of ampicillin, tetracycline and levofloxacin at the O & G Directorate for treating SSI should consider the resistant pattern of bacteria in this study. Infection reducing strategies should target women at high risk of developing SSIs such as those for emergency C/S, and women with more than 2 vaginal examinations before C/S.
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Philosophy in Clinical Microbiology in the Department of Clinical Microbiology School of Medical Science College of Health Science Kwame Nkrumah University of Science and Technology, Kumasi.