Post-Surgical C. difficile Linked to Antibiotic Overuse

For every hospital admission in the previous year, the odds of C. difficile infection increased by 14%, according to a recent study.

The overuse of antibiotics following a surgical procedure is associated with an increased risk of Clostridium difficile (C. difficile) infection, according to a new report.

Researchers from the University of Wisconsin School of Medicine & Public Health conducted their study at a 592-bed tertiary-care academic center in order to determine the incidence of postoperative C. difficile infection. The investigators examined 4 specific surgery specialties to categorize the risk factor in each: orthopedic surgery, neurosurgery, trauma surgery, and general surgery.

Over a period of 30 months, there were 11,310 admissions to the 4 included hospital units where a patient had an operation. Among those patients, 52 contracted C. difficile. The researchers concluded that the incidence was 0.80 cases per 1,000 patient days. Trauma surgery had the highest C. difficile infection rate at 9.5 cases per 1,000 admissions.

Rates of C. difficile were 4 to 5 times higher in the trauma and general surgery units than in the orthopedic and neurosurgery units. The researchers believe that this could be attributed to differences in patient factors such as overall health, antibiotic use, or healthcare settings. Surgical factors also play a role, such as intra-abdominal surgery trauma surgery compared to orthopedic joint surgery.

Study author James Bernatz, MD, told MD Magazine the study has significant importance "as the landscape of repayment for elective surgical procedures changes."

"With more surgeries being reimbursed as bundled payments, hospitals are pressured to limit costs," Bernatz said. "As Clostridium difficile infection has been found to increase length of stay by one week and double the cost of care, it is clearly a post-operative complication to be avoided."

Other factors that increased the odds of a surgical patient acquiring C. difficile included number of hospital admissions in the past year, antibiotic use in the past 6 months, use of antibiotics more than 24 hours post-operatively, and non peri-operative antibiotics use. These factors posed a similar risk when the researchers classified the data based on body mass index, ASA classification, and antibiotic use in the previous 6 months.

“Although the surgeon cannot necessarily control the antibiotics prescribed to their patients in the year leading up to surgery, they can control antibiotic administration in the peri-operative and post-operative period,” Bernatz said. “Antibiotics should be limited to one prophylactic preoperative dose (unless 24 hours of antibiotics are indicated). In the immediate post-operative period, antibiotics should be used judiciously.”

For every hospital admission in the previous year, the odds of C. difficile infection increased by 14%, researchers noted. Additionally, discharge to a skilled nursing facility compared to being discharged home also increased the likelihood that patients would acquire C. difficile infection.

“Further studies could examine the rate of Clostridium difficile infection between operations within one subspecialty to determine if certain operative variables or patient characteristics affect the post-operative risk of Clostridium difficile infection,” Bernatz said.

The study, “Antibiotic Overuse is a Major Risk Factor for Clostridium difficile Infection in Surgical Patients,” was published online in the journal Infection Control & Hospital Epidemiology.

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