Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt

BACKGROUND: The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. METHODS: The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. RESULTS: During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15–16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69–10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45–5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14–4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04–3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78–3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26–2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11–2.39; p = 0.021). CONCLUSIONS: The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.