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Clostridium difficile Infection in the Plastic Surgery Population: Lessons from the ACS NSQIP Database.

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Clostridium difficile infections (CDI) are rare in plastic surgery patients, occurring in only 0.1%. Risk factors include inpatient stays and contaminated wounds, suggesting a need for antibiotic stewardship guidelines.

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Area of Science:

  • Plastic Surgery
  • Infectious Disease Epidemiology
  • Healthcare-Associated Infections

Background:

  • Clostridium difficile infections (CDI) significantly impact patient morbidity and mortality.
  • Data on CDI incidence, impact, and risk factors in plastic surgery is limited.

Purpose of the Study:

  • To investigate the incidence, risk factors, and outcomes of CDI in plastic surgery patients.
  • To identify modifiable factors for CDI prevention in this population.

Main Methods:

  • Retrospective query of the ACS NSQIP database for plastic surgery cases in 2016.
  • Analysis of patient demographics, clinical characteristics, and CDI development.
  • Identification of independent variables associated with CDI development.

Main Results:

  • A total of 29,256 plastic surgery procedures were analyzed; 44 patients (0.1%) developed post-operative CDI.
  • Independent risk factors for CDI included contaminated wounds, COPD, trunk procedures, and pressure ulcer reconstruction.
  • Outpatient surgery decreased CDI odds, while inpatient stays >1 day increased risk.

Conclusions:

  • CDI are infrequent in plastic surgery, primarily linked to trunk/decubitus ulcer reconstructions and inpatient stays.
  • Evidence-based antibiotic stewardship guidelines are needed, especially for trunk reconstruction patients, to limit antibiotic use and reduce CDI incidence.