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Clostridium difficile infection in orthopaedic patients
H J Clarke1, R H Jinnah, R P Byank
1Johns Hopkins University, Francis Scott Key Medical Center, Baltimore, Maryland 21224.
The Journal of Bone and Joint Surgery. American Volume
|August 1, 1990
Summary
Clostridium difficile infection, often caused by antibiotic use, leads to severe diarrhea in orthopedic patients. Prompt diagnosis and treatment with metronidazole and vancomycin are crucial for managing this infection.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Orthopaedic Surgery
Background:
- Clostridium difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea.
- Orthopaedic patients are susceptible to CDI, particularly following antibiotic prophylaxis.
Observation:
- Twenty-five orthopaedic patients with CDI and diarrhea were identified.
- Antibiotic use, often prophylactic (cefazolin, clindamycin), was the primary cause.
- Delay in diagnosis correlated with increased disease severity, indicated by white blood cell counts > 20 x 10(9)/L.
Findings:
- Metronidazole is recommended for immediate treatment of suspected CDI in post-operative patients with unexplained fever or high WBC count and diarrhea.
- Vancomycin should be added for persistent, severe diarrhea confirmed by C. difficile toxin assay.
- Minimizing antibiotic prophylaxis duration can reduce the risk of C. difficile colitis.
Implications:
- Consider CDI in patients with symptoms mimicking intestinal obstruction.
- Early recognition and appropriate management are key to improving outcomes in CDI.
- Judicious use of prophylactic antibiotics is essential in preventing CDI in orthopaedic surgery.