DEVELOPMENT OF WOUND-INFECTION OR SEPARATION AFTER CESAREAN DELIVERY - PROSPECTIVE EVALUATION OF 2,431 CASES

Wound infections are a common surgical complication, often requiring a prolonged hospital stay and leading to increased costs. Over a one-ye ar period, 2,431 patients were followed after cesarean delivery with p rompt evaluation and culture of all suspicious wounds. Seventy subject s (2.8%) developed confirmed wound infection, and 42 (1.7%) developed noninfected open surgical wounds. Seven (0.3%) fascial dehiscences wer e diagnosed, requiring surgical repair. Forty of 63 (64%) infected wou nds had positive bacterial cultures, with Staphylococcus epidermidis ( 29%), Enterococcus faecalis (17%), Staphylococcus aureus (17%), Escher ichia coli (11%) and Proteus mirabilis (10%) the most frequent isolate s. Only 7 of 42 (17%) noninfected wounds had positive cultures, with o nly S aureus, S epidermidis and Corynebacterium species isolated. Nine ty-five percent of the noninfected wounds had blood or serous collecti ons present. Rupture of membranes lasting longer than six hours, emerg ency cesarean delivery and morbid obesity were associated with a stati stically increased likelihood of the development of infected wounds. E mergency cesarean delivery and morbid obesity, but not prolonged ruptu re of membranes, were associated with an increased likelihood of the d evelopment of noninfected wounds. Therefore, it appears that at least two mechanisms are responsible for the development of postcesarean ope n wounds: (1) increased amniotic fluid and wound colonization due to p rolonged rupture of membranes, resulting in a wound infection containi ng one or more bacterial species derived from the cervicovaginal flora , and (2) increased exogenous bacterial contamination and flora consis tent with skin species or breaks in sterile technique, often accompany ing difficult or emergency surgery.