الفهرس 
Chapter I: Post-cesarean wound infectionOnly 14 pages are availabe for public view
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Abstract
Bacterial infection is mostly a clinical concept that may need to be confirmed or ruled out with supportive bedside or laboratory investigations. The presence of inflammation or systemic dysfunction as well as direct or indirect evidence of a suitable bacterial infection are the two main elements that are always required to validate the diagnosis. Localized or systemic inflammatory response syndrome can develop from inflammation (SIRS) (Kaukonem et al., 2015)
The development of effective antibiotics, widespread immunization, and contemporary sanitation, infection control and prevention are currently improving. However, in many healthcare systems around the world, infection continues to be the cause of morbidity and mortality (Aslam et al., 2018).
Clinical and analytical testing are used to diagnose surgical site infection. An examination is conducted to look for any pus, abscess or inflammatory reaction at the surgical site before making the diagnosis. Additionally, an open incision and any pus or abscess that oozes from the site are both examined. A pus or tissue sample should be collected for a culture test and a routine blood count should be performed to check the leucocyte count, CRP and procalcitonin level. (Kothari, 2019).
Plasma Procalcitonin level is comparable with specific response of bacterial infection, particularly for invasive or probably-invasive bacteria. High concentration of Procalcitonin indicates sepsis, severe sepsis or even septic shock condition. It may also represent another possibility and gives additional information towards conventional clinical data. Some studies state that procalcitonin is better or at least has the same diagnosis potency with another infection marker such as procalcitonin, leukocytosis and fever. (Liu et al., 2017).
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So, the aim of this study was to evaluate the correlation between serum procalcitonin and severity of post cesarean wound infection. To elucidate our aim, this is a prospective cohort study included 64 patients In Obstetrics and Gynecology department at Faculty of Medicine,Menoufia university Hospital, Egypt. Duration of study lasted for two years.
The study population was divided into two groups:
group A: Those who were underwent secondary suture (No=32)
The participants who were develop post-cesarean surgical site infection and need a secondary suture for their wound care.
group B: Those who were not underwent Secondary suture (No=32)
The participants who were develop post-cesarean surgical site infection and follow-up them without need a secondary suture for their wounds.
Inclusion criteria:
Patients who were develop surgical site infection after their cesarean sections. To diagnosis an incisional SSI , at least one of the following was documented: purulent drainage from the wound, redness and/ or swelling of the incision and wound separation
Exclusion criteria:
History of chorioamnionitis, premature rupture of membranes or prolonged rupture of membrane ,urinary tract infections ,any infectious condition other than surgical site infection e.g. mastitis, pneumonia and upper respiratory tract infection.
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All women included in this study were subjected to the following:
- Written informed consent will be taken from all patients included in this study.
- Complete history and physical examination.
- At the time of admission, serum procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) was measured.
Primary Outcome Measures:
The primary outcome of the study was to compare baseline PCT levels between patients who required a secondary suture and patients who did not require a secondary suture for the treatment of incisional SSI after a cesarean section
The results of this study could be summarized as follow.
There was significant difference among studied groups according to parity, cesarean section, education, and income(p<0.05). While, there were no significant difference among studied groups according to age, BMI, and job (p>0.05).
In pre-operative investigation, TLC and CRP were significantly increased among secondary suture group than non-secondary suture group. While, Hb was significantly increased among non- Secondary suture group than Secondary suture group. Surgery durations were significantly increased among Secondary suture group than non-Secondary suture group.
In secondary suture group there were high significantly increased among post-operative than pre-operative regarding TLC and CRP (P= 0.001). While, there was high significantly increased found among pre-operative than post-operative regarding Hb (P=0.001). Also, in non- secondary suture group there were high significantly increase among post-operative than pre-operative regarding TLC and CRP (P=0.001).
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PCT was significantly higher among secondary suture group (237.66±48.45) than non-secondary suture group (161.94±25.55), (p= 0.001).
ROC curve analysis showed that serum procalcitonin (PCT) was the beast method for detection its level as a marker of post-cesarean wound infection, it had sensitivity 93.8%, and specificity 87.5% at AUC of 0.977 with cut off value ≥ 190.525.
Multiple logistic regression analysis indicated that PCT was the most significant predictor for Post-cesarean SSI management by secondary sutures with p value 0.035.