Zeynep BAYRAMOĞLU, Erhan OKUYAN, Hayrettin TAY, Adem YOLDAŞ

Evolution of microbial ecology: A rare multidrug-resistant (Enterobacter cloacae) surgical wound infection after cesarean delivery: Our experience of 5946 cesarean deliveries

To demonstrate the rapidly changing multidrug-resistant microbial environment and its challenges from the viewpoint ofmicrobiologists, pathologists, and obstetricians.In our research; upon our encounter with a rare multidrug resistance woundinfection following a cesarean section; we retrospectively analyzed 5946 cesarean sections performed in our clinic between 2017-2019. Of the 5946 patients, 978 (16.44%) were literate and 4968 (%83.56) were illiterate. The average age of our patients is 23.44and their average weight is 78.35 kg. The number of patients taken to emergency cesarean was 954, and 4992 of our patients wereoperated due to recurrent cesarean section. The number of patients operated under general anesthesia was 347, and 5599 patientsreceived spinal anesthesia. In 2 years, 5946 patients had surgical site infection in 23 (0.39%) patients. Only one of our patients hadmultidrug-resistant Enterobacter Cloacae. None of our patients with surgical site infection had maternal mortality. Drug-resistantbacterial infection increases hospital stay, healthcare costs, and mortality, and for all nations, this problem is growing exponentially.Nowadays, understanding the multifactorial genetic basis of multidrug resistance should investigate genetic signatures in invasiveinfection.

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1. Gregory KD, Jackson S, Korst L, et al. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol 2012;29:7-18.
2. Creanga AA, Bateman BT, Butwick AJ, et al. Morbidity associated with cesarean delivery in the United States: Is placenta accreta an increasingly important contributor? Am J Obstet Gynecol 2015;213:384-11.
3. Newlin C, Kuehl TJ, Pickrel A, et al. Cesarean section incision complications and associated risk factors: A quality assurance project. Open J Obstet Gynecol 2015;789-94.
4. Conner S, Verticchio J, Tuuli M, et al. Maternal obesity and risk of postcesarean wound complications. Am J Perinatol 2013;31:299-304.
5. Ayres-de-Campos D. Obesity and the challenges of caesarean delivery: Prevention and management of wound complications. Best Pract Res Clin Obstet Gynaecol 2015;29:406-14.
6. Dessie W, Mulugeta G, Fentaw S, et al. Pattern of bacterial pathogens and their susceptibility isolated from surgical site infections at selected referral hospitals, Addis Ababa, Ethiopia. Int J Microbiol 2016.
7. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. J İnfect Control 1988; 16:128-40.
8. Amatya J, Rijal M, Baidya R. “Bacteriological study of the postoperative wound samples and antibiotic susceptibility pattern of the isolates in BB hospital. J Sex Med 2015;3:1019.
9. Kabau DM, Wanjala S, Kagema F. Incidence and determinants of surgical site infection after Caesarean Delivery at Kenyatta National Hospital,”Incidence and determinants of surgical site infection after Caesarean Delivery atKenyatta National Hospital, 2014:51.
10. Mitt P, Lang K, Peri A, et al. Surgical-site infections following cesarean section in an Estonian university hospital: postdischarge surveillance and analysis of risk factors. Infection Control & Hospital Epidemiology 2005;26:449-54.
11. Mulu W, Kibru G, Beyene G, et al. Postoperative nosocomial infections and antimicrobial resistance pattern of bacteria isolates among patients admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. Ethiop J Health Sci 2012;22:7-18.
12. Annavajhala MK, Gomez-Simmonds A, Uhlemann AC. Multidrug-Resistant Enterobacter cloacae Complex Emerging as a Global, Diversifying Threat. Front Microbiol 2019;10:44.
13. Gardner SE, Frantz RA, Saltzman CL, et al. Diagnostic validity of three swab techniques for identifying chronic wound infection. Wound Repair Regen 2006;14:548-57.
14. Wayne PA. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing; 2011.
15. Ovington LGS. Hanging wet-to-dry dressings out to dry. Home Healthc Nurse 2001;19:477.
16. Martens MG, Kolrud BL, Faro S, et al. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA. J Reprod Med 1995 ;40:171-5.
17. Liu Z, Dumville JC, Norman G, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2018;2:CD012653.
18. Blumenfeld YJ, El-Sayed YY, Lyell DJ, et al. Risk factors for prolonged postpartum length of stay following cesarean delivery. Am J Perinatol 2015;32:825-32.
19. Olsen MA, Butler AM, Willers DM, et al. Comparison of costs of surgical site infection and endometritis after cesarean delivery using claims and medical record data. Infect Control Hosp Epidemiol 2010;31:872-5.
20. Goksever Celik H, Celik E, Dikmen S, et al. Surgical Site Infections in a Tertiary Referral Obstetric and Gynecologic Clinic Center in Istanbul and Review of the Literature. Gynecol Obstet Reprod Med 2018;24:37-41.
21. Yavuz E, Malatyalioglu E, Bildircin F. Vaginal Preparation with Povidone Iodine and Postcesarean Infectious Morbidity: A Retrospective Trial. Gynecology Obstetrics & Reproductive Med 2016;20:15-9.