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We conducted a matched case-control study to determine risk factors for the development of prosthetic joint infection. Cases were patients with prosthetic hip or knee joint infection. Controls were patients who underwent total hip or knee arthroplasty and did not develop prosthetic joint infection. A multiple logistic regression model indicated that risk factors for prosthetic joint infection were the development of a surgical site infection not involving the prosthesis (odds ratio [OR], 35.9; 95% confidence interval [CI], 8.3 -154.6), a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 (OR, 1.7; 95% CI, 1.2 -2.3) or 2 (OR, 3.9; 95% CI, 2.0 -7.5), the presence of a malignancy (OR, 3.1; 95% CI, 1.3 -7.2), and a history of joint arthroplasty (OR, 2.0; 95% CI, 1.4 -3.0). Our findings suggest that a surgical site infection not involving the joint prosthesis, an NNIS System surgical patient risk index score of 1 or 2, the presence of a malignancy, and a history of a joint arthroplasty are associated with an increased risk of prosthetic joint infection.

Background Clostridium difficile infection (CDI) is a common hospital-acquired infection with increasing incidence, severity, recurrence and associated morbidity and mortality. There is emerging data on the occurrence of CDI in non-hospitalized patients. However, there is a relative lack of community-based CDI studies, as most of the existing studies are hospital-based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired CDI. Methods To better understand the epidemiology of community-acquired Clostridium difficile infection, a population-based study was conducted in Olmsted County, Minnesota using the resources of the Rochester Epidemiology Project. Data regarding severity, treatment response, and outcomes were compared in community-acquired versus hospital-acquired cohorts, and changes in these parameters, as well as in incidence, were assessed over the study period. Results Community-acquired Clostridium difficile infection cases accounted for 41% of 385 definite CDI cases. The incidence of both community-acquired and hospital-acquired Clostridium difficile infection increased significantly over the study period. Compared to those with hospital-acquired infection, patients with community-acquired infection were younger (median age 50 years compared to 72 years), more likely to be female (76% versus 60%), had lower comorbidity scores, and were less likely to have severe infection (20% versus 31%) or have been exposed to antibiotics (78% versus 94%). There were no differences in the rates of complicated or recurrent infection in patients with community-acquired compared to hospital-acquired infection. Conclusions In this population-based cohort, a significant proportion of cases of Clostridium difficile infection occurred in the community. These patients were younger and had less severe infection than those with hospital-acquired infection. Thus, reports of Clostridium difficile infection in hospitalized patients likely underestimate the burden of disease and overestimate severity.

Background and Aims-We sought to assess the evolution of Crohn's disease behavior in an American population-based cohort.

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