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2017 ; 12
(6
): e0179117
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Antibiotic prophylaxis for surgical site infections as a risk factor for
infection with Clostridium difficile
#MMPMID28622340
Balch A
; Wendelboe AM
; Vesely SK
; Bratzler DW
PLoS One
2017[]; 12
(6
): e0179117
PMID28622340
show ga
OBJECTIVE: We aimed to measure the association between 2013 guideline concordant
prophylactic antibiotic use prior to surgery and infection with Clostridium
difficile. DESIGN: We conducted a retrospective case-control study by selecting
patients who underwent a surgical procedure between January 1, 2012 and December
31, 2013. SETTING: Large urban community hospital. PATIENTS: Cases and controls
were patients age 18+ years who underwent an eligible surgery (i.e., colorectal,
neurosurgery, vascular/cardiac/thoracic, hysterectomy, abdominal/pelvic and
orthopedic surgical procedures) within six months prior to infection diagnosis.
Cases were diagnosed with C. difficile infection while controls were not.
METHODS: The primary exposure was receiving (vs. not receiving) the recommended
prophylactic antibiotic regimen, based on type and duration. Potential
confounders included age, sex, length of hospital stay, comorbidities, type of
surgery, and prior antibiotic use. Crude and adjusted odds ratios (OR) and 95%
confidence intervals (CI) were calculated using logistic regression. RESULTS: We
enrolled 68 cases and 220 controls. The adjusted OR among surgical patients
between developing C. difficile infection and not receiving the recommended
prophylactic antibiotic regimen (usually receiving antimicrobial prophylaxis for
more than 24 hours) was 6.7 (95% CI: 2.9-15.5). Independent risk factors for
developing C. difficile infection included having severe comorbidities, receiving
antibiotics within the previous 6 months, and undergoing orthopedic surgery.
CONCLUSIONS: Adherence to the recommended prophylactic antibiotics among surgical
patients likely reduces the probability of being case of C. difficile. Antibiotic
stewardship should be a priority in strategies to decrease the morbidity,
mortality, and costs associated with C. difficile infection.