IMPACT OF C. DIFFICILE INFECTION IN ELECTIVE ORTHOPAEDIC SURGERY PATIENTS

Abstract

Introduction: Clostridium difficile associated diarrhoea (CDAD) has emerged as a healthcare associated infection of great clinical and economic significance. C. difficile is thought to cause about a quarter of cases of antibiotic-associated diarrhoea overall, but accounts for a greater proportion of more severe disease. The type ‘027’ strains are multi-resistant and cause severe morbidity and mortality. A retrospective audit was performed to study the effect of C. Difficile infection in elective orthopaedic surgery patients (hip/knee arthroplasties)

Material and Methods: All the patients who were diagnosed with C. Difficile after a primary elective joint arthroplasties, performed at the District general hospital during the three year study period from April2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intra-venous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

Results: A total of 1430 patients underwent primary hip or knee arthroplasties during the three years of study period. A total of 32 patients suffered from C. Difficile diarrhoea (2.2%) after the arthroplasty procedure, and within this cohort, 5 patients died during the same admission to the hospital (0.35%). The average length of stay for an elective lower limb joint arthroplasty was increased from 10 days to 43 days due to the affection with C. Difficile diarrhoea.

Discussion: C. difficile infection not only adds to the morbidity, but also causes significant increase in the mortality rate after elective joint replacement. The broad spectrum peri-operative antibiotics used to prevent infection after a joint replacement generally render the patient vulnerable to this highly lethal hospital bug. Introduction of simple hygiene measure such as hand-washing and change of peri-operative antibiotic protocol lead to a statistically significant reduction in the incidence of C. Dificcile infections after elective joint replacement surgery without compromising arthroplasty results.