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Clostridium difficile infection in the USA: incidence and associated factors in revision total knee arthroplasty patients

  • Original Article • KNEE - ARTHROSCOPY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Revision total knee arthroplasty (TKA) procedures performed secondary to periprosthetic joint infection (PJI) are associated with significant morbidity and mortality. These poor outcomes may be further complicated by postoperative infection requiring antibiotics. However, antibiotic overuse may suppress patients’ bacterial flora, leading to Clostridium difficile infection (CDI). Therefore, we aimed to study the: (1) incidence; (2) costs; and (3) risk factors associated with CDI in revision TKA patients.

Methods

The National Inpatient Sample database was queried for individuals diagnosed with PJI who underwent revision TKA between 2009 and 2013 (n = 83,806). Patients who developed CDI during their inpatient stay were identified (n = 799). Logistic regression analysis was conducted to assess the association between hospital- and patient-specific characteristics and the development of CDI.

Results

The incidence of CDI after revision TKA was 1.0%. These patients were older (mean age 69.05 vs. 65.52 years), had greater LOS (median 11 vs. 5 days) and greater costs ($30,612.93 vs. 18,873.75), and experienced higher in-hospital mortality (3.6 vs. 0.5%; p < 0.001 for all) compared to those without infection. Patients with CDI were more likely to be treated in urban, not-for-profit, medium/large hospitals in the Northeast or Midwest (p < 0.05 for all) and to have underlying depression (OR 4.267; p = 0.007) or fluid/electrolyte disorders (OR 3.48; p = 0.001).

Conclusion

Although CDI is rare following revision TKA, it can have detrimental consequences. We demonstrate that CDI is associated with longer LOS, higher costs, and greater in-hospital mortality. With increased legislative pressure to lower healthcare expenditures, it is crucial to identify means of preventing costly complications.

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Authors and Affiliations

  1. Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Chukwuweike U. Gwam, Nicole E. George, Jennifer I. Etcheson, John M. Tarazi, Ga-ram Han, Korie M. E. Griffith & Ronald E. Delanois

  2. Department of Orthopaedic Surgery, Center for Joint Preservation and Reconstruction, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10075, USA

    Michael A. Mont

Authors
  1. Chukwuweike U. Gwam
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  2. Nicole E. George
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  3. Jennifer I. Etcheson
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  4. John M. Tarazi
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  8. Ronald E. Delanois
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Correspondence to Ronald E. Delanois.

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Gwam, C.U., George, N.E., Etcheson, J.I. et al. Clostridium difficile infection in the USA: incidence and associated factors in revision total knee arthroplasty patients. Eur J Orthop Surg Traumatol 29, 667–674 (2019). https://doi.org/10.1007/s00590-018-2319-3

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  • DOI: https://doi.org/10.1007/s00590-018-2319-3

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