Risk Factors, Microbial Profile and Antibiotic Resistance Patterns of Surgical Site Infections Following Lower Segment Cesarean Section in Low-Income Population: A Prospective Cohort Study

Abstract

Background: Surgical site infections (SSIs) following lower segment cesarean section pose a significant health burden in low-income populations, yet comprehensive data on risk factors, microbial profiles, and antibiotic resistance patterns remain limited. This study aimed to investigate these aspects to inform evidence-based prevention and management strategies.

Methods: A prospective cohort study was conducted from January 2022 to October 2022 following 423 women who underwent cesarean section. Participants were monitored for 30 days post-surgery. Microbiological sampling and antibiotic susceptibility testing were performed for all suspected SSI cases. Risk factors were analyzed using multivariate logistic regression.

Results: The overall SSI incidence was 12.5% (53/423). Significant risk factors included obesity (adjusted OR 2.84, 95% CI 1.62-4.98), diabetes mellitus (adjusted OR 2.31, 95% CI 1.28-4.16), and prolonged operative time (adjusted OR 1.95, 95% CI 1.13-3.37). Staphylococcus aureus (28.1%) and Escherichia coli (23.4%) were the predominant pathogens. High resistance rates were observed for commonly used antibiotics, with over 60% of gram-negative isolates resistant to third-generation cephalosporins. SSI cases had significantly longer hospital stays (mean difference 4.2 days) and incurred additional costs of Rupees 2,845 per case.

Conclusions: This study demonstrates a substantial burden of post-cesarean SSIs in low-income populations, characterized by high antibiotic resistance rates and significant healthcare costs. The identified risk factors suggest potential areas for targeted interventions. These findings emphasize the need for context-specific prevention strategies and antimicrobial stewardship programs in resource-limited settings.