Management and Prevention of Recurrent Clostridium Difficile Infection in Patients After Total Joint Arthroplasty: A Review

Benjamin E. Stein, William Greenough, Simon C. Mears

Research output: Contribution to journalArticle

Abstract

Clostridium difficile infection (CDI) is the most common infectious cause of nosocomial diarrhea in elderly patients, accounting for 15% to 25% of all cases of antibiotic-induced diarrhea in those patients. Virulent forms of this organism have developed, increasing the associated morbidity, mortality, and complication rates. The average patient undergoing total joint arthroplasty is at particular risk of CDI because of advanced age, the use of prophylactic antibiotic coverage in the perioperative period, multiple comorbid conditions, and length of hospital stay. In addition, patients who have had one CDI are at risk of another; the rate of recurrent CDI (RCDI) is 15% to 30%. To review the available information on RCDI, we conducted an extensive literature search, focusing on its epidemiology and the management strategies for its treatment and prevention. We found the management of RCDI is a controversial topic, with as yet no consensus regarding specific treatment guidelines. Several experienced clinicians have published suggested treatment algorithms, but they are based on anecdotal experience. With regard to the prevention of RCDI, the literature is scarce, and currently, the only effective strategies remain judicious use of perioperative antibiotics and appropriate implementation of infection control procedures. There are several vaccination medications that are currently being studied but are not yet ready for clinical use. We agree with the approach to management of RCDI that has been proposed in several articles, that is, on confirmation of a first recurrence of CDI by a stool toxin assay and clinical symptoms, a 14-day course of metronidazole or vancomycin; for a second recurrence, a tapered-pulsed course of vancomycin; and, for 3 or more recurrences, a repeat course of the tapered-pulsed vancomycin and adjunctive Saccharomyces boulardii or cholestyramine.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalGeriatric Orthopaedic Surgery & Rehabilitation
Volume3
Issue number4
DOIs
StatePublished - 2012

Fingerprint

Clostridium Infections
Clostridium difficile
Arthroplasty
Joints
Vancomycin
Anti-Bacterial Agents
Recurrence
Diarrhea
Length of Stay
Organism Forms
Cholestyramine Resin
Perioperative Period
Metronidazole
Infection Control
Vaccination
Epidemiology
Therapeutics
Guidelines
Morbidity
Mortality

Keywords

  • arthroplasty
  • Clostridium difficile
  • infection
  • recurrent

ASJC Scopus subject areas

  • Surgery
  • Geriatrics and Gerontology
  • Rehabilitation
  • Orthopedics and Sports Medicine

Cite this

Management and Prevention of Recurrent Clostridium Difficile Infection in Patients After Total Joint Arthroplasty : A Review. / Stein, Benjamin E.; Greenough, William; Mears, Simon C.

In: Geriatric Orthopaedic Surgery & Rehabilitation, Vol. 3, No. 4, 2012, p. 157-163.

Research output: Contribution to journalArticle

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