Incidence of Post-cesarean wound infections, bacterial profiles, resistant patterns, and associated costs among women delivering at public hospitals in Eastern Ethiopia: multi center study

Abstract

Surgical site infection following cesarean section remains a serious public health issue worldwide, particularly in low and middle income countries. The global incidence of post-CS SSI recorded 5.63%. To determine the incidence of post-cesarean wound infections, bacterial profiles, resistant patterns, and associated costs among women delivering at public hospitals in Eastern Ethiopia. A hospital-based prospective study conducted at Hiwot Fana Specialized University Hospital, Dil Chora Referral Hospital, Dechatu Health center and Sabian General Hospital from January 01 to March 2025. Out of 427 mothers who underwent cesarean section were included. Socio-demographic data was gathered by personal interviews using a pre-tested questionnaire. Pus samples were collected using sterile cotton swab and inoculated in appropriate culture media. The Kirby-Bauer disk diffusion technique was employed to determine the antimicrobial resistance patterns of bacterial isolates. SPSS version 26 used to enter and analyze the data. From a total of 427 CS delivered mothers, 56 (13.1%) developed Post-CS SSI. Out of 56 isolates, 31 (55.3%) isolates were gram-positive organism and 25 (44.4%) isolates were gram-negative organisms. The predominant bacteria isolates were S. aureus (48.21%), K. pneumonia (17.8%), and E.coli (14.2%). The majority of isolates were resistant to tetracycline (83.3%), trimethoprim-sulfamethoxazole (88.8%), and amoxicillin-clavulanic acid (46.5%). Previous CS (p = 0.001), type of CS (p = 0.007), obesity (p < 0.001), hospital stay (p < 0.001), post-operative hemoglobin level (p = 0.015), residence (p = 0.006), and premature rupture of membrane (p < 0.001), showed statistically significant association with post-cesarean surgical site infection. The median(IQR) cost for laboratory, treatment, and hospital admission with and without post-cesarean surgical site infection were 894(126), 6161.50(551), and 3073(357) :540(219), 3334(1757), and 1600 (579) respectively. The incidence of post cesarean surgical site infection was 13.1% and extra costs incurred on patients and health facilities. Implementation of a regular infection control policy along with microbiological work could reduce the incidence of post-CS SSI.