C.DIFFICILE INFECTION: MORBIDITY AND MORTALITY FOLLOWING FRACTURE NECK OF FEMUR

Abstract

In 1990 an estimated 1.3 million hip fractures occurred worldwide. Clostridium difficile diarrhoea has emerged as a healthcare associated infection of great clinical and economic significance especially in the frail and vulnerable group of fracture neck of femur patients. The major risk factor is peri-operative antibiotic exposure especially cephalosporins. A retrospective audit was performed to study the effect of C. Difficile in operated fracture neck of femur patients.

All the patients who were diagnosed with C. Difficile infection after an operated fracture neck of femur at the District general hospital from April 2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intravenous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

A total of 1023 patients underwent surgery for fracture neck of femur during the three years of study period. The average age of the patients was 81 years. 80% of the patients were females. A total of 62 patients suffered from C. Difficile diarrhoea (6%) after the arthroplasty procedure, and within this cohort, 29 patients died during the same admission to the hospital (47%). The average length of stay for a patient with fracture neck of femur was increased from 23.4 to 60 days in those affected with C. Difficile.

The patients with fracture neck of femur are generally elderly with poor body reserves. C.difficile infection in such patients not only adds to the morbidity, but also causes significant increase in the mortality rate. Propagation of simple infection control measures such as hand-washing and isolation and change of peri-operative antibiotic protocol led to a statistically significant reduction in the incidence of C.Difficile infections after fracture neck of femur surgery.