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Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain.
Clin Infect Dis. 2008 Jun 15; 46(12):1838-43.CI

Abstract

BACKGROUND

Perioperative antibacterial prophylaxis (PAP) is an important component of surgical site infection prevention but may be associated with adverse effects, such as Clostridium difficile infection (CDI). Since the emergence of a hypervirulent strain of C. difficile, the risk of development of CDI after PAP has not been evaluated. The purpose of this study was to determine the risk of PAP-induced CDI after selected surgical procedures and to compare such risk before with such risk after the emergence of the hypervirulent strain of C. difficile.

METHODS

We performed a retrospective cohort study including all patients aged > or = 18 years who underwent either abdominal hysterectomy, hip arthroplasty, craniotomy, or colon, cardiac, or vascular surgery from August 1999 through May 2005 in a tertiary care hospital in Quebec, Canada.

RESULTS

A total of 8373 surgical procedures were performed, and PAP was used in 7600 of these interventions. Of 98 CDI episodes identified, 40 occurred after patients received PAP only. The risk of CDI was 14.9 cases per 1000 surgical procedures among patients who received PAP only during the period 2003-2005, compared with 0.7 cases per 1000 surgical procedures during the period 1999-2002 (P < .001). The independent risk factors associated with CDI in patients given PAP only were older age, administration of cefoxitin (rather than cefazolin) alone or in combination with another drug, and year of surgery.

CONCLUSIONS

In the context of a large epidemic of CDI associated with the emergence of a novel strain, 1.5% of patients who received PAP as their sole antibiotic treatment developed CDI. In situations in which the only purpose of PAP is to prevent infrequent and relatively benign infections, the risks may outweigh the benefits in some elderly patients.

Authors+Show Affiliations

Department of Microbiology and Infectious Diseases, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18462108

Citation

Carignan, Alex, et al. "Risk of Clostridium Difficile Infection After Perioperative Antibacterial Prophylaxis Before and During an Outbreak of Infection Due to a Hypervirulent Strain." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 12, 2008, pp. 1838-43.
Carignan A, Allard C, Pépin J, et al. Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis. 2008;46(12):1838-43.
Carignan, A., Allard, C., Pépin, J., Cossette, B., Nault, V., & Valiquette, L. (2008). Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(12), 1838-43. https://doi.org/10.1086/588291
Carignan A, et al. Risk of Clostridium Difficile Infection After Perioperative Antibacterial Prophylaxis Before and During an Outbreak of Infection Due to a Hypervirulent Strain. Clin Infect Dis. 2008 Jun 15;46(12):1838-43. PubMed PMID: 18462108.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. AU - Carignan,Alex, AU - Allard,Catherine, AU - Pépin,Jacques, AU - Cossette,Benoit, AU - Nault,Vincent, AU - Valiquette,Louis, PY - 2008/5/9/pubmed PY - 2008/7/4/medline PY - 2008/5/9/entrez SP - 1838 EP - 43 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 46 IS - 12 N2 - BACKGROUND: Perioperative antibacterial prophylaxis (PAP) is an important component of surgical site infection prevention but may be associated with adverse effects, such as Clostridium difficile infection (CDI). Since the emergence of a hypervirulent strain of C. difficile, the risk of development of CDI after PAP has not been evaluated. The purpose of this study was to determine the risk of PAP-induced CDI after selected surgical procedures and to compare such risk before with such risk after the emergence of the hypervirulent strain of C. difficile. METHODS: We performed a retrospective cohort study including all patients aged > or = 18 years who underwent either abdominal hysterectomy, hip arthroplasty, craniotomy, or colon, cardiac, or vascular surgery from August 1999 through May 2005 in a tertiary care hospital in Quebec, Canada. RESULTS: A total of 8373 surgical procedures were performed, and PAP was used in 7600 of these interventions. Of 98 CDI episodes identified, 40 occurred after patients received PAP only. The risk of CDI was 14.9 cases per 1000 surgical procedures among patients who received PAP only during the period 2003-2005, compared with 0.7 cases per 1000 surgical procedures during the period 1999-2002 (P < .001). The independent risk factors associated with CDI in patients given PAP only were older age, administration of cefoxitin (rather than cefazolin) alone or in combination with another drug, and year of surgery. CONCLUSIONS: In the context of a large epidemic of CDI associated with the emergence of a novel strain, 1.5% of patients who received PAP as their sole antibiotic treatment developed CDI. In situations in which the only purpose of PAP is to prevent infrequent and relatively benign infections, the risks may outweigh the benefits in some elderly patients. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18462108/Risk_of_Clostridium_difficile_infection_after_perioperative_antibacterial_prophylaxis_before_and_during_an_outbreak_of_infection_due_to_a_hypervirulent_strain_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/588291 DB - PRIME DP - Unbound Medicine ER -