Abstract
Clostridioides difficile is still one of the most common causes of hospital-acquired infectious diarrhea (CDI), and the incidence of CDI is one of the indicators that allows conclusions to be derived on the correctness of antibiotic administration. The objective of this observational study was the analysis of post-discharge CDI incidence in patients undergoing hip or knee arthroplasty, in order to specify optimum conditions for the surgical procedures and outpatient postoperative care. One-year observational study. Public Polish hospitals. Retrospective records for 83,525 surgery patients having undergone hip or knee arthroplasty were extracted from the Polish National Health Fund databases. CDI and/or antibiotic prescriptions in the 30 day post-surgery period were expressed per 1000 surgeries with antibiotic prescription on discharge or in ambulatory care, respectively. The CDI incidence rate was 34.4 per 10,000 patients, and 7.7 cases per 100,000 post-surgery patient-days. Patients who were prescribed at least one antibiotic were diagnosed with CDI more often than patients who had no antibiotic treatment (55.0/1000 patients vs. 1.8/1000 patients). In the multifactorial analysis, the following factors were significant: being at least 65 years of age, trauma as the cause of surgery, length of stay over 7 days, HAIs other than CDI and taking beta-lactams and/or quinolones but not macrolides in the post-discharge period. Postoperative antibiotic prescription in patients undergoing joint replacement surgery is the main risk factor for CDI. These observations indicate the necessity of improvement of infection control programs as the key factor for CDI prevention.
Highlights
Clostridioides difficile is the most frequent cause of nosocomial diarrhea syndrome with possible severe progression
Patients who required Combination ABX therapy in the postoperative period suffered from causes of hospital-acquired infectious diarrhea (CDI) significantly more often than patients who did not undergo such therapy, as follows: 2.8/1000 patients vs. 1.8/1000 patients (Table 1)
In patients admitted in an emergency, post-discharge CDI was diagnosed significantly more often (4.6/1000 patients) than in patients admitted for scheduled procedures (1.7/1000 patients) (Table 1)
Summary
Clostridioides difficile is the most frequent cause of nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease is associated with higher health system costs, as well as exposing patients to additional health risks [1]. CDI (Clostridioides difficile infection) is usually associated with healthcare; the number of community-acquired infections is on the rise. CDIs are most frequently related to changes in the gut microbiota caused by the administration of antibiotics, and patients who are elderly, immunocompromised or have undergone surgery are at a greater risk of developing CDI and recurrent infection [2]. Healthcare-associated infections, considered as some of the most important public health problems, can be effectively prevented by implementing evidence-based methods of infection prevention and control. Effective implementation involves monitoring of process and outcomes indicators.
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