REDUCING CLOSTRIDIUM DIFFICILE INFECTION AND MORTALITY IN FRACTURE NECK OF FEMUR PATIENTS

Abstract

Background: Clostridium difficile (C diff) diarrhoea is a growing UK hospital problem. However, it is controversial whether patients die with C diff or of C diff. A series of infection control measures were introduced from August 2006 onwards to reduce the rate of C diff infection and to treat patients suffering from diarrhoea. These included a five-day antibiotic stop policy, a diarrhoea treatment policy, a hand washing campaign, increased investment in environmental cleaning and a change in policy for antimicrobial prophylaxis to coamoxiclav instead of cefuroxime. The aim of this study was to assess the impact of these measures on the incidence of C diff infection and to record the mortality associated with C diff. Fracture neck of femur patients were chosen as they are at particular risk.

Method: We assessed data on orthopaedic admissions in particular fracture neck of femur patients, C diff samples, and mortality up to one year. The incidence of C diff was compared between fracture neck of femur patients and other orthopaedic admissions and also before and since the introduction of the infection control policies. This was followed by a comparison of mortality between C diff positive patients and a control group matched by age, sex, ASA grade and place of residence. Mortality data was at 30days, 6 month and 1 year.

Results: Clostridium difficile was much more common in patients with fracture neck of femur (72 out of 1800, 4%) than in other orthopaedic admissions (51 out of 10000, 0.5%, p < 0.001). The incidence of C diff in patients with fracture neck of femur decreased from 49 of 548 (9%) in the 9 months pre-policy to 28 of 562 (5%, p=0.009) in the 9 months since policy Introduction: In those with C diff, mortality at 30 days and 6 months was 10/49 (20%) and 35/49 (71%) pre-policy and 9/28 (32%) and 20/28 (71%) since policy Introduction: Regardless of policy introduction, the overall mortality in 168 C diff positive patients at 30days, 6 months and 1 year was 31 (19%), 112 (67%) and 117 (70%) whilst that in the 168 matched controls was 19 (11%), 43 (26%) and 48 (29%).

Conclusion: The matched group data indicates that C diff increases mortality. It does not simply colonise the most frail. The percentage of deaths in C diff positive patients was no different after the diarrhoea treatment policy Introduction: The incidence of C diff was reduced by 43% using infection control measures. Our results indicate that the best way to reduce mortality due to C diff is to reduce the incidence, our current treatment policy was ineffective or in other words, ‘prevention was better than cure’. We recommend that similar measures could be introduced in other orthopaedic units in order to reduce the incidence and mortality in fracture neck of femur patients from Clostridium difficile.