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“Risk factors for surgical site infections following cesarean delivery in urban safety-net hospitals”

Published online by Cambridge University Press:  10 April 2025

Khaleda Akter ,
Megan Folks Open the ORCID record for Megan Folks [Opens in a new window] ,
Temilola-Azeezat Bakare ,
Mary Fornek ,
Briana Episcopia ,
Marie Abdallah ,
Ngozi Nwankpa  and
John Quale Open the ORCID record for John Quale [Opens in a new window]
Khaleda Akter
Affiliation:
Department of Medicine, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
Megan Folks*
Affiliation:
Department of Infection Prevention, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
Temilola-Azeezat Bakare
Affiliation:
Department of Infection Prevention, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
Mary Fornek
Affiliation:
Department of Infection Prevention, NYC Health + Hospitals/Central Office, New York, NY, USA
Briana Episcopia
Affiliation:
Department of Infection Prevention, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
Marie Abdallah
Affiliation:
Department of Medicine, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
Ngozi Nwankpa
Affiliation:
Department of Obstetrics and Gynecology, NYC Health + Hospitals/Jacobi Medical Center and North Central Bronx, Bronx, Nk, USA
John Quale
Affiliation:
Department of Medicine, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA
*
Corresponding author: Megan Folks; Email: [email protected]
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Abstract

Objective:

To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population.

Design:

Retrospective case-control study and multivariable regression analyses.

Setting:

Multicenter urban hospital system.

Participants:

All women undergoing C-sections during 2023.

Methods:

To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs.

Results:

Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY.

Conclusions:

For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.

Keywords

surgical site infection (SSI)cesarean section (C-section)risk factorspropensity matchingantibiotic prophylaxisretrospective case-control studymultivariable regression analysis
Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 5
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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