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Clostridium difficile Infection: An Orthopaedic Surgeon’s Guide to Epidemiology, Management, and Prevention

Anderson, Paul A. MD; Bernatz, James BS; Safdar, Nasia MD, PhD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 2017 - Volume 25 - Issue 3 - p 214–223
doi: 10.5435/JAAOS-D-15-00470
Review Article

Clostridium difficile infection is a growing concern in health care and is a worrisome complication in orthopaedics. The incidence and severity of this infection are increasing, although the incidence following orthopaedic surgery is comparatively lower than that seen in patients in most other surgical specialties. The typical geriatric orthopaedic patient may have many risk factors that increase the likelihood of C difficile infection, including advanced age, residence in a long-term care facility, multiple comorbidities, the use of perioperative antibiotics, and a long length of stay. Many antibiotics used for prophylaxis in orthopaedic procedures have been correlated with an increased incidence of C difficile infection. The indications for C difficile testing may vary, and diagnostic methods differ in sensitivity and specificity. The prevention of this infection is multifaceted and consists of practitioner and patient hand hygiene, antibiotic stewardship, contact precautions, and proper environmental cleaning. The main treatment options are metronidazole for mild cases and vancomycin for moderate to severe disease. Up to 40% of cases may have one or more recurrence. Further research is needed to identify novel therapeutic and prevention strategies for C difficile infection.

From the Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Dr. Anderson or an immediate family member has received royalties from Pioneer Surgical and Stryker; serves as a paid consultant to B. Braun Aesculap and Stryker; serves as an unpaid consultant to Expanding Orthopedics, SI-Bone, SparTEC, and Titan Surgical; has stock or stock options held in Expanding Orthopedics, Pioneer Surgical, SI-Bone, SparTEC, and Titan Surgical; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Society for Testing and Materials, the Lumbar Spine Research Society, the North American Spine Society, the Spine Arthroplasty Society, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Spine Section. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Bernatz and Dr. Safdar.

Dr. Safdar acknowledges support by the Veterans Health Administration National Center for Patient Safety (Veterans Health Administration MERIT Review Award, Patient Safety Center Grant).

Received September 01, 2015

Accepted April 30, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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