Factors and common bacterial pathogens associated with post-caesarean wound sepsis at Hoima regional referral hospital, Uganda

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Kampala international international: School of Health Sciences
Background: Post-caesarean wound sepsis is among the most common problem for patientswho undergo caesarean section. It remains a common and widespread problem contributing to morbidity and mortality; this could be due to an increase in antimicrobial resistant bacterial pathogens. Therefore, a study to identify and document the factors associated with wound sepsis and common bacterial pathogens can provide solution to prevent incidence and establish microbiological mapping, and this is the intension for this research. Objectives: To determine prevalence, identify factors, common bacterial pathogens from post-caesarean wounds and antibacterial susceptibility pattem at Hoima Regional Referral Hospital.Research methods: This was a cross-sectional study conducted among patients with postcaesareanwound sepsis in the post-natal wards at Hoima Regional Referral Hospital. Consecutive enrolment of 303 participants who consented to participate was done daily until a required sample size was realized from July to September, 2018. Structured questionnaires were used to collect data on associated factors and wound swabs were done. Culturing for colony characteristics followed by Gram stain was used for provisional identity of pathogenic bacteria. Further identification was done by a set of biochemical tests. Antibacterial susceptibility pattem of isolated bacterial pathogens was determined by Kirby Bauer disc diffusion method. Data was analyzed using STAT A VERSION 14.2. Results: The wound sepsis rate was 16.8%. Being educated, multiple vaginal examination, hygiene, previous caesarean sections and HIV seropositivity were all significantly associated with wound sepsis (P value <0.05). Majority of the wound swab specimen yielded Staphylococcus aureus, and the least-prevalent pathogen was Proteus mirabilis. Coliforms showed high susceptibility to Imipenem followed by Staphylocccocus aureus to ciprofloxacin. Resistance was highest for coliforms and Staphylococcus aureus against, ciprofloxacin, gentamycin, ceftriaxone and cotrimoxazole. Conclusions and recommendations: The rate of caesarean wound sepsis is high at Hoima Regional Refenal Hospital. Being educated, multiple vaginal examination, hygiene, previous caesarean sections and HIV sero-positivity are significantly associated with wound sepsis. Staphylococcus au reus is the commonest organism isolated from exudates of septic wounds after caesarean section. Health workers should be informed about the high prevalence, the identified associated factors and common pathogens for proper management and also rational use of antibiotics to combat resistance.
A dissertation submitted in partial fulfillment of the requirements for the a ward of the degree of Master of medicine in obstetrics and Gynecology of Kampala International University
Obstetrics and Gynecology, Common bacterial pathogens, Post-Cesarean, Wound sepsis, Hoima regional referral hospital, Uganda