Bacteriological profile of postoperative wound infection in LSCS patients in MKCG Medical College, Berhampur

Abstract

Background: Post-lower segment cesarean section (LSCS) infection is a common complication and is mainly responsible for a longer hospital stay, higher treatment cost, and maternal mortality. Aim: To isolate and identify the different bacterial spp. in patients with postoperative LSCS wound infection and to determine their antimicrobial susceptibility. Material and Methods: Pus samples were collected from 30 patients with infected LSCS wounds using two sterile swabs from each patient from May 2019 to July 2019. One was used for Gram stain and the other inoculated into blood agar and MacConkey agar. The bacterial isolates were identified using a standard protocol. An antimicrobial susceptibility test was carried out using the Kirby Bauer disk diffusion method. Double-disk diffusion and E-test using Cefotaxime (CTX)/CTX+and Ceftazidime (CAZ)/CAZ+ were done for Extended Spectrum beta lactamases (ESBL) producer. All isolates were put in Congo red agar to see the biofilm production. Results: Out of 30 samples, 76% (22) were culture positive. The predominant age group was 20–30 years. Gestational diabetes and hypertension were the common risk factors. Pond bathing was a major predisposing factor. Of the 23 isolates, 65.2% (15) were gram-positive and 34.8% (8) were gram-negative bacteria. Among the gram-positive isolates, Staphylococcus aureus was the predominant isolate (80%) and the other being Enterococcus and M. tuberculosis. Among the gram-negative isolates, Acinetobacter was predominant (50%) followed by Pseudomonas, Escherichia coli, and Klebsiella. All the gram-positive isolates were sensitive to linezolid and vancomycin while among the gram-negative isolates, Escherichia coli, Pseudomonas spp., and Klebsiella spp. were 100% sensitive to piperacillin-tazobactam. A case of multidrug resistance Acinetobacter was found. Of all the isolates, two were ESBL producers, and five were biofilm producers. Those were also methicillin-resistant Staphylococcus aureus (MRSA). Conclusions: A majority of the LSCS wound infection was due to gram-positive bacteria. Educating the patients about personal hygiene and antimicrobial prophylaxis is thought to decrease the incidence of LSCS wound infection.