Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p < 0.001), and 99.8% of the women received antibiotic(s). The antibiotic combination of benzylpenicillin, gentamicin, and metronidazole was the most commonly prescribed (n = 39, 146.7%), followed by ceftriaxone (n = 349, 41.6%). Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.