title: Clostridium difficile-associated diarrhoea in primary joint arthroplasty in Aneurin Bevan University Health Board South.
abstract: BACKGROUND
  The choice of perioperative antibiotics to reduce the prevalence of infection after joint arthroplasty should be considered carefully to minimise the risk of nosocomial infections. Dramatic increases in the incidence and severity of healthcare-associated Clostridium difficile infection with Clostridium difficile-associated diarrhoea (CDAD) have occurred since 2000.
  
  
  METHODS
  A retrospective audit of patients who underwent total hip and total knee replacement between 1 January 2005 and 31 December 2007 was undertaken in Aneurin Bevan University Health Board South (ABHBS). Stool samples from patients who had diarrhoea <12 months of surgery were recorded. Positive samples for CDAD <1 month of surgery were identified. After the change in practice in June 2010, a re-audit linked joint-replacement patients between 1 July 2010 and 26 June 2013 with infection control-records for CDAD-positive cases.
  
  
  RESULTS
  In the first audit cycle, 1900 joint procedures were carried out in 1845 patients. There were 4 cases of CDAD <1 month of surgery (0.22%). In the re-audit period, 2591 joint procedures were undertaken in 2400 patients: no cases of CDAD <1 month of surgery were recorded. Fisher's exact test gave a two-tailed p=0.036.
  
  
  CONCLUSIONS
  The significant reduction in CDAD cases after the change in perioperative antibiotic regimen for primary joint arthroplasty mirrored a 66% reduction in overall CDAD cases in the ABUHBS between 2008 and 2012. This reduction was accompanied by financial savings in antibiotics and nursing hours.
authors.affiliation: Royal Gwent Hospital , Newport , Wales.
authors.forename: O
authors.initials: O
authors.lastname: Blocker
authors.affiliation: Royal Gwent Hospital , Newport , Wales.
authors.forename: U
authors.initials: U
authors.lastname: Abdulkadir
authors.affiliation: Royal Gwent Hospital , Newport , Wales.
authors.forename: P
authors.initials: P
authors.lastname: Roberts
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001178:Arthroplasty / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014852:Wales / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Arthroplasty; Clostridium difficile
references.citation: J Arthroplasty. 2008 Sep;23(6):839-42
references.pmid: 18534454
references.citation: J Bone Joint Surg Br. 2010 Jul;92(7):994-8
references.pmid: 20595121
references.citation: Eur J Orthop Surg Traumatol. 2014 May;24(4):539-43
references.pmid: 24178085
references.citation: J Arthroplasty. 2014 Jun;29(6):1110-3
references.pmid: 24530206
references.citation: N Engl J Med. 2011 Nov 3;365(18):1693-703
references.pmid: 22047560
references.citation: Surgeon. 2013 Feb;11(1):20-4
references.pmid: 22709532
references.citation: Eur J Surg Suppl. 1992;(567):19-21
references.pmid: 1381636
references.citation: Eur J Clin Microbiol Infect Dis. 1999 Feb;18(2):113-9
references.pmid: 10219575
references.citation: Nephrol Dial Transplant. 2013 Mar;28(3):612-9
references.pmid: 23197677
references.citation: Clin Orthop Relat Res. 2013 Oct;471(10):3178-85
references.pmid: 23479237
references.citation: Infect Control Hosp Epidemiol. 2010 May;31(5):431-55
references.pmid: 20307191