Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2018 Jan;33(1):205-210.e1. doi: 10.1016/j.arth.2017.08.004. Epub 2017 Aug 12.
An improved understanding of Clostridium difficile is important as it is used as a measure of hospital quality and is associated with substantial morbidity. This study utilizes the National Surgical Quality Improvement Program to determine the incidence, timing, risk factors, and clinical implications of C difficile colitis in patients undergoing primary total hip or knee arthroplasty (THA or TKA).
Patients who underwent primary THA or TKA as part of the 2015 National Surgical Quality Improvement Program were identified. The primary outcome was a diagnosis of C difficile colitis within the 30-day postoperative period. Risk factors for the development of C difficile colitis were identified using Poisson multivariate regression.
A total of 39,172 patients who underwent primary THA or TKA were identified. The incidence of C difficile colitis was 0.10% (95% confidence interval [CI] 0.07-0.13). Of the cases that developed C difficile colitis, 79% were diagnosed after discharge and 84% had not had a preceding infection diagnosed. Independent preoperative and procedural risk factors for the development of C difficile colitis were greater age (most notably ≥80 years old, relative risk [RR] 5.28, 95% CI 1.65-16.92, P = .008), dependent functional status (RR 4.05, 95% CI 1.44-11.36, P = .008), preoperative anemia (RR 2.52, 95% CI 1.28-4.97, P = .007), hypertension (RR 2.51, 95% CI 1.06-5.98, P = .037), and THA (vs TKA; RR 2.25, 95% CI 1.16-4.36, P = .017). Postoperative infectious risk factors were urinary tract infection (RR 10.66, 95% CI 3.77-30.12, P < .001), sepsis (RR 17.80, 95% CI 3.77-84.00, P < .001), and "any infection" (RR 6.60, 95% CI 2.66-16.34, P < .001).
High-risk patients identified in this study should be targeted with preventative interventions and have perioperative antibiotics judiciously managed.
由于艰难梭菌被用作衡量医院质量的指标，并与大量发病率相关，因此深入了解艰难梭菌很重要。本研究利用国家外科质量改进计划，确定在接受初次全髋关节或膝关节置换术（THA 或 TKA）的患者中，艰难梭菌结肠炎的发生率、时间、危险因素和临床意义。
确定作为 2015 年国家外科质量改进计划一部分而接受初次 THA 或 TKA 的患者。主要结局是在术后 30 天内诊断出艰难梭菌结肠炎。使用泊松多变量回归确定艰难梭菌结肠炎发展的危险因素。
共确定了 39172 例接受初次 THA 或 TKA 的患者。艰难梭菌结肠炎的发生率为 0.10%（95%置信区间[CI]0.07-0.13）。在发生艰难梭菌结肠炎的病例中，79%在出院后诊断，84%没有诊断出先前的感染。发生艰难梭菌结肠炎的术前和手术独立危险因素包括年龄较大（尤其是≥80 岁，相对风险[RR]5.28，95%CI1.65-16.92，P=0.008）、功能依赖状态（RR4.05，95%CI1.44-11.36，P=0.008）、术前贫血（RR2.52，95%CI1.28-4.97，P=0.007）、高血压（RR2.51，95%CI1.06-5.98，P=0.037）和 THA（与 TKA 相比；RR2.25，95%CI1.16-4.36，P=0.017）。术后感染危险因素包括尿路感染（RR10.66，95%CI3.77-30.12，P<0.001）、败血症（RR17.80，95%CI3.77-84.00，P<0.001）和“任何感染”（RR6.60，95%CI2.66-16.34，P<0.001）。
本研究中确定的高危患者应针对这些患者进行预防干预，并谨慎管理围手术期抗生素。
