High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study

Abstract

Background: Caesarean sections (CS) are associated with a higher incidence of surgical site infections (SSI) compared to vaginal delivery. International studies and research from peripheral hospitals in Cameroon have documented the prevalence and risk factors for SSI after CS. However, data from referral hospitals in Douala, Cameroon remains scarce. This prospective study aims to investigate the incidence and risk factors for SSI following CS in Laquintinie and Douala Gynaeco-obstetric and Paediatric hospital, two major referral hospitals in Douala. By identifying modifiable factors associated with SSI, this study hopes to contribute to the development of strategies to control this significant hospital-acquired complication. Methods: Between February 1st and July 31st, 2022, 444 women undergoing caesarean section were enrolled in a prospective study conducted at two referral hospitals (Laquintinie hospital and Douala Gynaeco-Obstetric Hospital) in Douala, Cameroon. Standardized data collection captured sociodemographic, obstetric, and management details (pre-operative, intra-operative and post-operative information) for patients presenting with surgical site infection. Patients were followed up for 30 after caesarean section and SSI. Descriptive statistics and multivariable logistic regression analysis identified factors associated with SSI (p < 0.05). Results: The overall incidence of SSI was 45/444 (10.13%). Laquintinie Hospital had a higher rate (11.11%) compared to Douala Gynaeco-Obstetric Hospital (6.45%). Multivariate analysis identified obesity (aOR = 5.9, p = 0.032), pre-surgical anemia (aOR = 4.7, p = 0.03), and diabetes (aOR = 15.7, p = 0.013) as independent risk factors for SSI. Blood transfusion also emerged as a risk factor (aOR = 0.05, p = 0.013). Conclusion: This study revealed a concerningly high rate of SSI after CS in Douala referral hospitals. Addressing pre-surgical anemia, diabetes, and obesity may contribute to reducing SSIs. Further research is needed to identify causative bacteria and optimize antibiotic strategies.