title: Changing prophylactic antibiotic protocol for reducing Clostridium difficile-associated diarrhoeal infections.
abstract: OBJECTIVE
  To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile-associated diarrhoeal infections.
  
  
  METHODS
  Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime-based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection.
  
  
  RESULTS
  There were 32 cases of C difficile-associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile-associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p = 0.004), particularly in the trauma patients (from 8 to 3%, p = 0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p = 0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p = 0.46) or elective (p = 0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol.
  
  
  CONCLUSIONS
  Changing antibiotic protocol is one way of reducing the incidence of C difficile-associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.
authors.affiliation: Department of Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, UK.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Obaydi
authors.forename: Chris D
authors.initials: CD
authors.lastname: Smith
authors.forename: Pedro
authors.initials: P
authors.lastname: Foguet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000008:administration & dosage; D016360:Clostridioides difficile; D015331:Cohort Studies; D003967:Diarrhea / Q000382:microbiology* / Q000517:prevention & control*; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005436:Floxacillin / Q000008:administration & dosage; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D017334:Teicoplanin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005436:Floxacillin; D017334:Teicoplanin; D002444:Cefuroxime