Changing Prophylactic Antibiotic Protocol for Reducing Clostridium Difficile—Associated Diarrhoeal Infections

Purpose. To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile–associated diarrhoeal infections. Methods. Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime–based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection. Results. There were 32 cases of C difficile–associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile–associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p=0.004), particularly in the trauma patients (from 8 to 3%, p=0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p=0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p=0.46) or elective (p=0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol. Conclusion. Changing antibiotic protocol is one way of reducing the incidence of C difficile–associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.