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

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

doi:10.1007/s00590-018-2319-3

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…Of the 34 775 articles identified (Figure), 119 were full-text articles, and 86 (72.3%) of those articles met the selection criteria and were included in the systematic literature review . Among these, 66 articles evaluated incidence, and 20 articles evaluated LOS .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies [69][70][71][72][73][74][75][76][77][78] evaluated surgical patients (Table 3), and, thus, we assumed that the CDI cases were incident cases. Five studies 73,[75][76][77][78] used data from AHRQ NIS. These AHRQ NIS studies analyzed a variety of surgical procedures, including spine surgery 76 ; hip, 73 knee, 77 or lower-extremity 78 arthroplasty; and elective colon resections.…”

Section: Incident Cases Of CDI (36 Studies)mentioning

confidence: 99%

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

“…Five studies 73,[75][76][77][78] used data from AHRQ NIS. These AHRQ NIS studies analyzed a variety of surgical procedures, including spine surgery 76 ; hip, 73 knee, 77 or lower-extremity 78 arthroplasty; and elective colon resections. 75 One of them had CDI occurring in 1.4% of patients, for a rate of 144.99 cases of C difficile colitis per 10 000 elective colon resections, and the incidence increased from 1.31% in 2004 to 1.67% in 2006.…”

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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IMPORTANCE An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. OBJECTIVE To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. STUDY SELECTION Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I 2 value. Data analysis was performed in February 2019. MAIN OUTCOMES AND MEASURES Incidence of CDI and CDI-associated hospital LOS in the United States. RESULTS When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). CONCLUSIONS AND RELEVANCE Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Incident Cases Of CDI (36 Studies)mentioning

confidence: 99%

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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“…In comparison, the literature on depression and infectious diseases is less developed. Depression is associated with a significantly increased acquisition of the common cold [5], Clostridium (Clostridioides) difficile infection following total knee replacement surgery [6], bloodstream infection [7], enterovirus infection [8], and is associated with increased risk of infection following elective shoulder arthroplasty [9]. To date, there is limited evidence of the impact of depression on influenza illness and outcomes, though a review of the sparse literature concluded that there is an absence of evidence to support or refute a link between depression and risk for influenza acquisition.…”

Section: Introductionmentioning

confidence: 99%

Depression is associated with decreased severity and lower mortality in non-elderly hospitalized adults with influenza in the United States

Wiemken¹

2020

JRI

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Background: Depression is associated with risk for chronic disease, though its relationship with infectious diseases is less understood. Depression may modify the clinical outcomes of patients with infectious diseases such as influenza via its association with inflammation. The objective of this study was to evaluate the relationships between depression and clinical outcomes in non-elderly adults with influenza infection. Methods: This was a secondary analysis of the Nationwide Inpatient Sample database, years 2012-2016. Hospitalized adults aged 18-65 admitted during each influenza season were included. Depression status was documented via ICD-10 codes. The association between depression and clinical outcomes (e.g. disease severity, length of hospital stay, and inpatient all-cause mortality) were evaluated using multivariable regression modeling. Results: A total of 44,292 patients were included, 12% with depression. After adjustment for confounding, non-elderly influenza patients with depression had a 3.8% decreased risk of a severe disease (95% CI: 1.9%-5.7%; P<0.001), no difference in length of stay (Hazard Ratio: 0.99, 95% Confidence Interval 0.96-1.02), and lower all-cause in-hospital mortality versus those without depression (Odds Ratio=0.76; 95% CI 0.59-0.97; P=0.028). Conclusions: This study suggests that in non-elderly hospitalized patients with influenza, depression is associated with a decreased severity of illness and acute mortality. Chronic inflammation in those with depression may enhance the ability of the immune response to limit influenza infection or reduce pathologic acute inflammation associated with influenza disease.

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C. Difficile Infection within 6 Months before TKA Is Associated with Increased Short-Term Complications

et al. 2023

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A history of Clostridium difficile infection (CDI) before total knee arthroplasty (TKA) may be a marker for poor patient health and could be used to identify patients with higher risks for complications after TKA. We compared the frequency of 90-day postoperative CDI, complications, readmissions, and associated risk factors in (1) patients experiencing CDIs more than 6 months before TKA, (2) patients experiencing CDIs in the 6 months before TKA, and (3) patients without a history of CDI. We identified patients who underwent primary TKAs from 2010 to 2019 and had a history of CDI before TKA (n = 7,195) using a national, all-payer database. Patients were stratified into two groups: those with CDIs > 6 months before TKA (n = 6,027) and those experiencing CDIs ≤ 6 months before TKA (n = 1,168). These patients were compared with the remaining 1.4 million patients without a history of CDI before TKA. Chi-square and unadjusted odds ratios (ORs) with 95% confidence intervals (CI) were used to compare complication frequencies. Prior CDI during either timespan was associated with higher unadjusted odds for postoperative CDI (CDI > 6 months before TKA: OR 8.03 [95% CI 6.68–9.63]; p < 0.001; CDI ≤ 6 months before TKA: OR 59.05 [95% CI 49.66–70.21]; p < 0.001). Patients with a history of CDI before TKA were associated with higher unadjusted odds for 90-day complications and readmission compared with patients without a history of CDI before TKA. Other comorbidities and health metrics were not found to be associated with postoperative CDI (i.e., age, obesity, smoking, antibiotic use, etc.). Conclusion CDI before TKA was associated with higher odds of postoperative CDI compared with patients without a history of CDI. CDI ≤ 6 months before TKA was associated with the highest odds for postoperative complications and readmissions. Providers should consider delaying TKA after CDI, if possible, to allow for patient recovery and eradication of infection.

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

Cited by 6 publications

References 24 publications

Incidence and Outcomes Associated WithClostridium difficileInfections

Incidence and Outcomes Associated WithClostridium difficileInfections

Depression is associated with decreased severity and lower mortality in non-elderly hospitalized adults with influenza in the United States

C. Difficile Infection within 6 Months before TKA Is Associated with Increased Short-Term Complications

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