title: Clostridium difficile in patients undergoing primary hip and knee replacement.
abstract: Antibiotic prophylaxis is routinely administered during joint replacement surgery and may predispose patients to Clostridium difficile-associated disease (CDAD). The primary aim of this study was to determine the incidence of this following joint replacement, using a cefuroxime-based regimen. Patients developing CDAD were compared with a control group of patients without CDAD. The incidence of the former was 1.7 per 1000 primary joint replacements. Those patients prescribed additional antibiotics had a higher incidence of CDAD (p = 0.047), but there was no difference between the two groups in relation to the use of gastroprotective agents (p = 0.703). A trial of a new prophylaxis regimen would require 43 198 patients in each arm to show a reduction of one case per 1000 procedures. Cefuroxime-based antibiotic prophylaxis is safe in patients undergoing primary elective joint replacement.
authors.affiliation: Department of Orthopaedic, Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, UK. paul@jenkinsnet.org.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Jenkins
authors.forename: K
authors.initials: K
authors.lastname: Teoh
authors.forename: P M
authors.initials: PM
authors.lastname: Simpson
authors.forename: J
authors.initials: J
authors.lastname: Dave
authors.forename: A H W R
authors.initials: AH
authors.lastname: Simpson
authors.forename: S
authors.initials: S
authors.lastname: Breusch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002444:Cefuroxime / Q000008:administration & dosage; D016360:Clostridioides difficile; D003428:Cross Infection / Q000209:etiology; D004334:Drug Administration Schedule; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime