Surgical site infection in obstetrics & gynaecology

Key Statistics

• 2–6% — SSI incidence, high-income countries
• 60–70% — SSI/endometritis reduction with prophylactic antibiotics
• £959–1300 — Extra cost per SSI (UK)

Don't-miss facts

1. SSI onset: superficial/deep ≤30 days (no implant) or ≤1 year (implant) after surgery

2. Antibiotics: single IV dose within 60 min before skin incision – reduces SSI/endometritis/serious infection by 60–70%

3. Co-amoxiclav before CS → ↑ neonatal necrotising enterocolitis – give after cord clamping

4. Redose if surgery >3h or blood loss >1500 ml; cefazolin 3 g if >120 kg (standard 2 g)

5. Skin prep: alcohol-chlorhexidine first-line (NICE); dry for 3 minutes before incision

6. No prophylaxis needed for clean uncomplicated surgery (diagnostic laparoscopy, simple cystectomy, sterilisation)

7. NICE: sutures not staples for CS skin closure; SC closure only helps if fat >2 cm

8. Fever >38°C ×2, ≥4h apart, >24h post-op → evaluate for SSI (typical onset 4–7 days)

SSI rates by procedure

Vaginal hysterectomy (Sweden) 11.6%

Abdominal hysterectomy (Sweden) 3.79%

LSCS (Sweden) 3.76%

Abdominal hysterectomy (England NHS audit) 1.6%

CS – worldwide reported range, upper end 15.0%

Selected rates reported across studies in the review

Abbreviation Key

• SSI — surgical site infection
• MSSA — methicillin-sensitive Staphylococcus aureus
• CDC — Centers for Disease Control
• CoNS — coagulase-negative staphylococci
• NICE — National Institute for Health and Care Excellence
• RCT — randomised controlled trial
• ACOG — American College of Obstetricians and Gynecologists
• RR — relative risk
• WHO — World Health Organization
• OR — odds ratio
• ACS — American College of Surgeons
• CI — confidence interval
• SIS — Surgical Infection Society
• IV — intravenous
• MRSA — methicillin-resistant Staphylococcus aureus
• MIC — minimum inhibitory concentration
• CS — caesarean section
• ASA — American Society of Anaesthesiology
• NPWT — negative pressure wound therapy
• NHS — National Health Service
• ERAS — enhanced recovery after surgery
• FDA — Food and Drug Administration
• CRP — C-reactive protein
• SC — subcutaneous

Source: Ekanem E et al. Surgical site infection in obstetrics and gynaecology: prevention and management. The Obstetrician & Gynaecologist 2021;23:124–137. doi:10.1111/tog.12730

Clinically reviewed by NHS obstetricians and gynaecologists

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