Post‐Caesarean Wound Infection: A Review of the Risk Factors.

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Abstract
EDITORIAL COMMENT: This paper presents a careful appraisal of infection rates after Caesarean section in a teaching hospital. The overall infection rate was 9.4% which seems low in view of the fact that the criteria for infection were unusually strict although these did not include pyrexia; in 2.4% of patients the infection was deep with drainage of purulent material. Wound sepsis is important because of patient morbidity and cost, hospitalization being increased in this series by 2 days when wounds became infected. Such studies are difficult, because antibiotics are used widely (39% in this study) and even in those with more severe degrees of pyrexia (above 38d̀ C on 2 or more occasions), 74% of patients in this series had no evidence of wound infection. Another problem inevitable in such a study is that there is no record of wound problems after the patient was discharged from hospital. It would be helpful to know if the patients who develop stitch abscesses or breakdown of the wound after discharge from hospital are those who receive prophylactic antibiotics or antibiotic therapy because of pyrexia. In many hospitals it is common practice for the surgeon to give antibiotic therapy if the patient develops pyrexia; usually bacteriological studies are not performed in such patients since there is no discharge to culture. It is also difficult to know how to interpret the bacteriological findings in the 28% of patients whose troublesome wounds were cultured. Summary: In a prospective study of 1,546 patients delivered by Caesarean section a wound infection developed in 146 (9.4%); the rate was significantly higher in clinic patients (15.8%) compared with private patients (6.0%). Elective operations resulted in a lower incidence of wound infection (7.9%) than emergency operations (12.3%). Other factors significantly associated with postoperative wound infection were: the number of vaginal examinations before surgery (p<0.05), duration of operation (p< 0.005), vertical skin incision (p<0.05) and category of surgeon (p<0.001). In 56 patients for whom a past history was available, there was a record of a wound infection in 31 (55%). Clinic patients were over‐represented in all situations predisposing to wound infection.

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