934. Clostridium difficile and Surgery: A multi-center observational evaluation
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • 934_IDWPOSTER.pdf (265.6 kB)
  • Background:  Antibiotic surgical prophylaxis is often necessary to prevent infection but the benefit of antibiotics must be weighed against the risks which include Clostridium difficile infection (CDI).  New surgical prophylaxis guidelines recommend discontinuation of antibiotics at incision closure.  One potential advantage to decreasing unnecessary antibiotics is the reduction of CDI.  However, it is unclear how much of our current CDI is related to surgical prophylaxis.

    Methods: We performed a multi-center observational evaluation of eight hospitals in two states.  Using the facilities surgical schedule and cross-referencing it with the National Healthcare Safety Network (NHSN) CDI database a nine-month time period was evaluated for patients who underwent surgery and developed CDI within 30 days post-op.  Patients were excluded if they had CDI diagnosed prior to surgery or if they received antibiotics other than those used for pre or post-op prophylaxis.  

    Results: During the study period 31,904 inpatient surgeries were performed and a total of 729 CDI cases occurred; 313 community onset (CO) and 416 hospital onset (HO) or community onset healthcare facility associated (CO-HCFA).  Once the surgical schedule was cross-referenced against CDI patients 356 (49%) were identified as having both CDI and surgery with 172 (24%) developing CDI within 30 days after surgery. After chart review and evaluation for exclusion criteria 41 (6%) patients were determined as possibly developing CDI due to surgical prophylaxis.

    Conclusion: In our multi-center evaluation we observed that 6% of all CDI may be related to surgical prophylaxis.  However, surgical patients often have a complicated hospitalization and receive multiple courses of antibiotics making it difficult to determine the true amount of CDI that is related to surgical prophylaxis.  The development of CDI, with the use of routine, guideline driven antibiotic prophylaxis as the only antibiotic exposure, is concerning.  Prophylactic antibiotic use should be limited to that which has been proven to benefit the patient.

    Mandelin Cooper, Pharm.D., BCPS, Division Pharmacy, HCA Continental Division; Parallon Supply Chain Solutions, Denver, CO, John Hammer, MD, Denver Infectious Diseases Consultants, Denver, CO; Rose Medical Center, Denver, CO, Brent Morris, Pharm.D., M.B.A, Division Pharmacy, HCA Continental Division--Parallon Supply Chain Solutions, Denver, CO and Gary Winfield, MD, HCA Continental Division, Denver, CO


    M. Cooper, None

    J. Hammer, None

    B. Morris, None

    G. Winfield, None

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