Post Caesarean Section Surgical Site Infection, Microbial Patterns and Sensitivity to Antibiotics Among Women Who Delivered at Kenyatta National Hospital Between 2014 and 2020.

Abstract

Introduction: Surgical site infection (SSI) is a common complication following a Caesarean section which places an emotional and physical burden to a mother and has a significant financial burden to the health care system. SSI infections have been associated with maternal morbidity and mortality, and it is expected that the incidence of these infections are likely to go up with increasing number of Caesarean sections. At the Kenyatta National Hospital, being the largest referral hospital in Kenya has a Caesarean rate of about 30% of the total deliveries. There have been limited studies documenting the microbiology of the infections resulting from Caesarean deliveries at this setting. Objectives: The objective of this study was to describe the characteristics of patients with SSIs and to determine the microbial pattern and sensitivity to antibiotics among women with surgical site infection post Caesarean delivery at the Kenyatta National Hospital. Methodology: This was a cross sectional study of women who underwent a CS at the Kenyatta National Hospital and later developed surgical site infections. Clinical records of a total of 149 women who developed Surgical Site Infection (SSI) were examined. Demographic and clinical data were collected via an electronic data collection form. Data was analyzed using STATA version 15. Descriptive statistics were summarized as mean (standard deviation), median (Interquartile range) or frequencies (percentage). Results have been presented in tables and graphs. Results: A total of 149 participant data were used. The mean age of participants was 27 (6.9) years, ranging between 15-45 years. Majority of the participants, 63/149(42.3%) had attained primary school education while 59/149 (39.6% and 27/149 (18.1%) had secondary and tertiary education respectively. Most of the participants were Christian 143/149 (96.0%), Unemployed 104/149 (69.8%) and most were married 121/149 (81.2%). A total of 83 out of the 149 (55.7%) participants had a positive culture, while 66/149 (44.3%) had negative culture. The organisms grown by culture was E.coli 23/83 (27.2%), Staphylococcus aureus 16/83 (19.3%), Klebsiella pneumoniae 9/83 (10.8%) and Acinetobacter baumanii 2 9/83(10.8%). Other organisms grown were coagulase negative staphylococcus 8(9.6.%), enterococcus faecalis (4.8%) and others (4.8%).E.coli isolates were mostly sensitive to meropenem(82.5%) and mostly resistant to cephalosporins(62.5).Staphylococcus aureus isolates were most susceptible to gentamicin (75.0%)and were most resistant to benzyl penicillinampicillin (68.8%) .Klebsiella pneumonia isolates were most sensitive to meropenem(80%) and most resistant to cephalosporins(50%). Conclusion: The most isolated organism was E.coli, which was mostly sensitive to meropenem and mostly resistant to cephalosporin.