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Abstract
RÉSUMÉ
Introduction. L’infection du site opératoire contribue à l’augmentation de la morbidité maternelle liée à la césarienne. L’objectif de ce travail était de décrire les facteurs associés aux infections du site opératoire après une césarienne à l’Hôpital Central de Yaoundé, à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé et au Centre Hospitalier Universitaire de Yaoundé. Méthodologie. Étude transversale analytique des cas de césarienne réalisés du 17 Octobre 2017 au 15 Juin 2018. L’échantillonnage était consécutif et non probabiliste. Les tailles de l’échantillon des groupes cas et témoins étaient respectivement de 57 et 228. Le test de chi 2 et le test exact de Fisher ont été utilisés pour apprécier l’homogénéité entre les groupes, l’Odd Ratio avec son ¨Pintervalle de confiance à 95% a été utilisé pour apprécier l’association entre les variables. Résultats. Un total de 310 dossiers médicaux de césarienne ont été collectés dont 62 dossiers de patientes présentant une infection du site opératoire. La fréquence des infections du site opératoire dans la période d’étude était de 1,81%. La moyenne d’âge était de 27± 5 ans [14 - 46 ans], la tranche d’âge de 20 à 29 ans étant la plus représentée (170/310) avec un nombre plus élevé chez les patientes infectées. Les facteurs associés aux infections du site opératoire étaient : la rupture prématurée des membranes (OR : 2,065 ; IC 95% 1,051-4,057; p=0,035), l’incision médiane (OR=5,267 ; IC 95% ; 1,417-19,575); p=0,013), le médecin résident (OR=1,984 ; IC 95% 1,097-3,590; p=0,024). Conclusion. La fréquence des infections du site opératoire au cours de notre étude était de 1,81%. Les facteurs associés aux infections du site opératoire après césarienne sont la rupture prématurée des membranes, l’incision médiane, la qualification du praticien en tant que médecin résident.
ABSTRACT
Introduction. Surgical site infection contributes to the increase in maternal morbidity associated with cesarean section. Objectives. The identify the factors associated with surgical site infections after a caesarean section at the Central Hospital of Yaoundé, at the Gyneco-Obstetric and Pediatric Hospital of Yaoundé and at the University Hospital of Yaoundé. Methodology. Analytical cross-sectional study with retrospective collection including cesarean section cases performed from October 17, 2017 to June 15, 2018. The sampling was consecutive and not probability. The sample sizes of the case and control groups were 57 and 228, respectively. The chi-square test and Fisher's exact test were used to assess the homogeneity between the groups, the Odd Ratio with its 95% confidence interval was used to assess the association between the variables. Results. A total of 310 medical records of cesarean section were used for our study, i.e. 62 records of patients with an infection of the surgical site. The frequency of surgical site infections during our study was 1.81%. The average age was 27 ± 5 years [14 and 46 years]; the 20-29 age group was the most represented (170/310) with a higher number in infected patients. Factors associated with surgical site infections were: premature rupture of membranes (OR: 2.065; 95% CI 1.051-4.057; p = 0.035), median incision (OR = 5.267; 95% CI; 1.417-19.575); p = 0.013), resident physician (OR = 1.984; 95% CI 1.097-3.590; p = 0.024). Conclusion. The frequency of surgical site infections during our study was 1.81%. Factors associated with post-cesarean surgical site infections are premature rupture of membranes, midline incision, practitioner qualification as resident physician.
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References
- U.S.National librery of medicine. Cesarean Section - A Brief History: Part 1. [cited 2017 Nov 2019]; Available from: https://www.nlm.nih.gov/exhibition/cesarean/part1.html
- Lurie S, Glezerman M. The history of cesarean technique. Am J Obstet Gynecol 2003; 189 (6) :1803–6.
- Deneux-Tharaux C. Utérus cicatriciel : aspects épidémiologiques. J Gynécologie Obs Biol Reprod 2012 ; 41(8):697–707.
- Nkwabong E, Kouam L. Indication des cesariennes à la maternité du CHU de Yaoundé de 2000 A 2004. Clin Mother Child Health 2006; 3(1):453–5.
- Leke R. Mortalite maternelle. Postgrad Res Train Reprod Heal [Internet]. 2004 [cited 2019 Nov 20]; Available from: https://www.gfmer.ch/Medical_education_En/Cameroon/
- Barbut F, Carbonne B, Truchot F, Spielvogel C, Jannet D, Goderel I . Infections de site opératoire chez les patientes césarisées : bilan de 5 années de surveillance. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 2004 ; 33(6) : 487-496.
- Vitenskap M. Infections after caesarean sections. J Nor Med Assoc. 2009;(1):2–6.
- Gong S, Guo H, Zhou H, Chen L, Yu Y. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province , China. J Obstet Gynaecol Res 2012;38(3):509–15.
- Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. risk factors for surgical site infections. infect control and hosp epid 2014;22(10):613–7.
- Leaper CE. World Health Organization:Global Guidelines for the Prevention of Surgical Site Infection. J Hosp Infect 2017;95(2):135–6.
- Jido T, Garba I. Surgical-site infection following cesarean section in Kano, Nigeria. Ann Med Health Sci Res 2012;2(1):33–6.
- Ngowa JDK, Ngassam A, Fouogue JT, Metogo J, Medou A, Kasia JM. Complications maternelles précoces de la césarienne: A propos de 460 cas dans deux hopitaux universitaires de Yaoundé, Cameroun. Pan Afr Med J 2015;21:265.
- Vijayan CP, Mohandas S, Nath AG. Surgical Site Infection Following Cesarean Section in a Teaching Hospital. Intern Journ of Scient Study 2016;3(12):97–101.
- Goderel I, Lejeune V, Milliez J. Travail original Infections de site opératoire chez les patientes. J Gynecol Obstet Biol Reprod 2011;487–96.
- Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section. Infect Control Hosp Epidemiol 2008;29(6):477–84.
- Fouedjio JH, Fouelifack Ymele F, Esiene A, Tatah FM, Essiben F, Mbu RE. Maternal and Fetal Outcome in Cesarean Section in Three Referral Hospitals of Yaoundé: What Are the Places of the Type of Anesthesia and the Experience of the Surgeon? Health Sci. Dis 2020; 21 (2) : 39-45.
- Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control 2014;3(25):1–10.
- Wodajo S, Mehretu SG. Magnitude and Factors Associated With Post-Cesarean Surgical Site Infection at Hawassa University Teaching and Referral Hospital, Southern Ethiopia: A Cross-sectional Study. Ethopian J Heal Sci 2017; 27(3):283–290.
- Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: Results from a multicentre cohort study. BJOG An Int J Obstet Gynaecol 2012;119(11):1324–33.
- Thornburg LL, Linder MA, Durie DE, Walker B, Pressman EK, Glantz JC. Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery. J Matern Neonatal Med 2012; 25:1544–8.
References
U.S.National librery of medicine. Cesarean Section - A Brief History: Part 1. [cited 2017 Nov 2019]; Available from: https://www.nlm.nih.gov/exhibition/cesarean/part1.html
Lurie S, Glezerman M. The history of cesarean technique. Am J Obstet Gynecol 2003; 189 (6) :1803–6.
Deneux-Tharaux C. Utérus cicatriciel : aspects épidémiologiques. J Gynécologie Obs Biol Reprod 2012 ; 41(8):697–707.
Nkwabong E, Kouam L. Indication des cesariennes à la maternité du CHU de Yaoundé de 2000 A 2004. Clin Mother Child Health 2006; 3(1):453–5.
Leke R. Mortalite maternelle. Postgrad Res Train Reprod Heal [Internet]. 2004 [cited 2019 Nov 20]; Available from: https://www.gfmer.ch/Medical_education_En/Cameroon/
Barbut F, Carbonne B, Truchot F, Spielvogel C, Jannet D, Goderel I . Infections de site opératoire chez les patientes césarisées : bilan de 5 années de surveillance. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 2004 ; 33(6) : 487-496.
Vitenskap M. Infections after caesarean sections. J Nor Med Assoc. 2009;(1):2–6.
Gong S, Guo H, Zhou H, Chen L, Yu Y. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province , China. J Obstet Gynaecol Res 2012;38(3):509–15.
Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. risk factors for surgical site infections. infect control and hosp epid 2014;22(10):613–7.
Leaper CE. World Health Organization:Global Guidelines for the Prevention of Surgical Site Infection. J Hosp Infect 2017;95(2):135–6.
Jido T, Garba I. Surgical-site infection following cesarean section in Kano, Nigeria. Ann Med Health Sci Res 2012;2(1):33–6.
Ngowa JDK, Ngassam A, Fouogue JT, Metogo J, Medou A, Kasia JM. Complications maternelles précoces de la césarienne: A propos de 460 cas dans deux hopitaux universitaires de Yaoundé, Cameroun. Pan Afr Med J 2015;21:265.
Vijayan CP, Mohandas S, Nath AG. Surgical Site Infection Following Cesarean Section in a Teaching Hospital. Intern Journ of Scient Study 2016;3(12):97–101.
Goderel I, Lejeune V, Milliez J. Travail original Infections de site opératoire chez les patientes. J Gynecol Obstet Biol Reprod 2011;487–96.
Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section. Infect Control Hosp Epidemiol 2008;29(6):477–84.
Fouedjio JH, Fouelifack Ymele F, Esiene A, Tatah FM, Essiben F, Mbu RE. Maternal and Fetal Outcome in Cesarean Section in Three Referral Hospitals of Yaoundé: What Are the Places of the Type of Anesthesia and the Experience of the Surgeon? Health Sci. Dis 2020; 21 (2) : 39-45.
Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control 2014;3(25):1–10.
Wodajo S, Mehretu SG. Magnitude and Factors Associated With Post-Cesarean Surgical Site Infection at Hawassa University Teaching and Referral Hospital, Southern Ethiopia: A Cross-sectional Study. Ethopian J Heal Sci 2017; 27(3):283–290.
Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: Results from a multicentre cohort study. BJOG An Int J Obstet Gynaecol 2012;119(11):1324–33.
Thornburg LL, Linder MA, Durie DE, Walker B, Pressman EK, Glantz JC. Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery. J Matern Neonatal Med 2012; 25:1544–8.