Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis

M Farid Mojtahedi; M Sepidarkish; M Almukhtar; Y Eslami; F Mohammadianamiri; K Behzad Moghadam; S Rouholamin; M Razavi; M Jafari Tadi; A Fazlollahpour-Naghibi; Z Rostami; A Rostami; M Rezaeinejad

doi:10.1016/j.jhin.2023.05.019

Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis

J Hosp Infect. 2023 Sep:139:82-92. doi: 10.1016/j.jhin.2023.05.019. Epub 2023 Jun 10.

Authors

M Farid Mojtahedi¹, M Sepidarkish², M Almukhtar³, Y Eslami⁴, F Mohammadianamiri⁵, K Behzad Moghadam⁶, S Rouholamin⁷, M Razavi⁸, M Jafari Tadi⁹, A Fazlollahpour-Naghibi⁵, Z Rostami⁵, A Rostami⁵, M Rezaeinejad¹⁰

Affiliations

¹ Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
³ Harlem Medical Centre, Bridgeview, IL, USA.
⁴ Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
⁵ Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
⁶ Independent Researcher, USA.
⁷ Department of Obstetrics and Gynaecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁸ Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
⁹ Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, USA.
¹⁰ Department of Obstetrics and Gynaecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: mahroo.rezaeinejad1397@gmail.com.

PMID: 37308061
DOI: 10.1016/j.jhin.2023.05.019

Abstract

Background: Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors.

Methods: International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I².

Results: In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified.

Conclusion: An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.

Keywords: Caesarean section; Global incidence; Meta-analysis; Surgical site infection.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

COVID-19* / complications
Cesarean Section / adverse effects
Female
Humans
Incidence
Pregnancy
Staphylococcal Infections* / epidemiology
Surgical Wound Infection / prevention & control