Incidence, Risk Factors, and Impact of Clostridium difficile Colitis Following Primary Total Hip and Knee Arthroplasty

Bovonratwet, Patawut; Bohl, Daniel D.; Malpani, Rohil; Nam, Denis; Valle, Craig J. Della; Grauer, Jonathan N.

doi:10.1016/j.arth.2017.08.004

Cited by 34 publications

(30 citation statements)

References 38 publications

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“…Ten studies [69][70][71][72][73][74][75][76][77][78] evaluated surgical patients (Table 3), and, thus, we assumed that the CDI cases were incident cases. Five studies 73,[75][76][77][78] used data from AHRQ NIS.…”

Section: Incident Cases Of CDI (36 Studies)mentioning

confidence: 99%

Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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IMPORTANCE An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. OBJECTIVE To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. STUDY SELECTION Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I 2 value. Data analysis was performed in February 2019. MAIN OUTCOMES AND MEASURES Incidence of CDI and CDI-associated hospital LOS in the United States. RESULTS When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). CONCLUSIONS AND RELEVANCE Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.

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Section: Incident Cases Of CDI (36 Studies)mentioning

confidence: 99%

Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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“…Although higher, this finding is similar to previous primary TJA studies which have described the incidence of CDAD between 0.07 and 0.17%. [5][6][7][8][9] Septic rTHA was revealed to have a CDAD incidence of 1.1% following surgery. Delanois et al 10 reported similar findings to this study.…”

Section: Discussionmentioning

confidence: 99%

“…Stepwise logistic regression was used to identify risk factors for CDAD and a missing indicator was used to address missing values. 6,15 Odds ratios (OR) with 95% confidence intervals (CIs) denote the effect of each predictor on CDAD, and p < 0.05 was set as the level of significance. Statistical analysis was performed using R software (version 3.1.3).…”

Section: Methodsmentioning

confidence: 99%

Incidence and Risk Factors for Clostridium Difficile-Associated Diarrhea Following Revision Total Hip Arthroplasty

et al. 2019

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Clostridium difficile-associated diarrhea (CDAD) is a well-known cause of complications and increased hospital cost following surgery. As CDAD rates continue to be adopted as a quality metric by institutions, it is important to detect high-risk patients prior to surgery, including revision total hip arthroplasty (rTHA). This study was performed to identify the incidence and risk factors of CDAD within 30 days of rTHA. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was accessed from 2015 to 2016 to identify rTHA procedures. Overall, 4,178 patients were included. Preoperative and perioperative variables were analyzed as potential risk factors for the development of CDAD. To compare categorical variables, Chi-square and Fisher's exact tests were used, while t-tests were used to detect differences in continuous variables. Independent risk factors for CDAD were identified using stepwise logistic regression. The rate of CDAD was found to be 0.5% (20/4,178) within 30 days of rTHA. Preoperative functional dependence (odds ratio [OR] = 3.34; p = 0.035) and dyspnea (OR = 3.80; p = 0.019), were statistically significant risk factors for the development of CDAD after rTHA. Septic revision was not a significant risk factor for CDAD (OR = 2.50; p = 0.082). The incidence of CDAD after rTHA in the United States is approximately 0.5%. Independent risk factors for CDAD include preoperative functional dependence and dyspnea. High-risk patients must be identified prior to surgery and antibiotic selection for other infections should be managed judiciously.

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“…An improved understanding of prevention of Clostridium difficile infection (CDI) is important among elderly patients undergoing an orthopedic surgery, as CDI is associated with substantial morbidity [1]. We experienced CDI patients at Matsumoto Orthopedic Surgical Hospital with a rate of 4.9 cases per 10 ,000 patient bed-days in 2015, which is as many as in previous reports such as EUCLID (the EUropean, multicentre, prospective biannual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhoea), which reported 7.3 cases per 10, 000 patient bed-days in 2013 [2].…”

mentioning

confidence: 99%

“…C. difficile is an anaerobic, gram-positive, spore-forming bacillus that colonizes the intestinal tract after alteration of the normal gastrointestinal flora, usually by antibiotic therapy [6]. CDI is associated with increased cost, morbidity, and mortality in postoperative patients [1]. CDI prevention among orthopedic surgical patients is of extreme importance because prophylactic antibiotic treatment is usually provided after an operation.…”

mentioning

confidence: 99%

Combination probiotics may prevent <i>Clostridium difficile</i> infection among elderly patients undergoing an orthopedic surgery

Nagamine¹,

Matsumoto²,

Nakamura³

2019

Bioscience of Microbiota, Food and Health

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The incidence of Clostridium difficile infection (CDI) is greater in elderly orthopedic patients. We conducted a retrospective case-control study by selecting elderly patients who underwent proximal femoral fracture surgery to investigate the effect of probiotics on CDI prevention. Cases were diagnosed with CDI by an enzyme-linked immunosorbent assay for C. difficile toxins using frozen stool specimens. The primary method of exposure was receipt of combination probiotics such as Streptococcus faecalis, Bacillus mesentericus, and Clostridium butyricum. The crude odds ratio between developing CDI and receiving combination probiotics was 0.074 (95% CI: 0.010–0.565; p=0.002). Adjunctive combination probiotics among elderly patients who undergo proximal femoral fracture surgery likely reduces the probability of CDI.

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Incidence, Risk Factors, and Impact of Clostridium difficile Colitis Following Primary Total Hip and Knee Arthroplasty

Cited by 34 publications

References 38 publications

Incidence and Outcomes Associated WithClostridium difficileInfections

Incidence and Outcomes Associated WithClostridium difficileInfections

Incidence and Risk Factors for Clostridium Difficile-Associated Diarrhea Following Revision Total Hip Arthroplasty

Combination probiotics may prevent <i>Clostridium difficile</i> infection among elderly patients undergoing an orthopedic surgery

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