Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain
Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain
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DOI：
10.1086/588291
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发表时间：
2008-06-15
影响因子：
11.8
通讯作者：
Valiquette, Louis
中科院分区：
文献类型：
--
作者：
Carignan, Alex;Allard, Catherine;Valiquette, Louis
背景围手术期抗菌预防（PAP）是手术部位感染预防的重要组成部分，但可能与不良反应相关，如艰难梭菌感染（CDI）。自从一株C.尽管CDI的发生率很高，但PAP后发生CDI的风险尚未评估。本研究的目的是确定在选定的外科手术后PAP诱导的CDI的风险，并比较在出现C. difficile.Methods.我们进行了一项回顾性队列研究，包括1999年8月至2005年5月在加拿大魁北克三级保健医院接受经腹子宫切除术、髋关节置换术、开颅术或结肠、心脏或血管手术的所有年龄≥ 18岁的患者。共进行了8373例外科手术，其中7600例使用PAP。在确定的98次CDI发作中，40次发生在患者仅接受PAP治疗后。在2003 - 2005年期间，仅接受PAP的患者中，CDI的风险为14.9例/1000例外科手术，而1999 - 2002年期间为0.7例/1000例外科手术（P
Background. Perioperative antibacterial prophylaxis (PAP) is an important component of surgical site infection prevention but may be associated with adverse effects, such as Clostridium difficile infection (CDI). Since the emergence of a hypervirulent strain of C. difficile, the risk of development of CDI after PAP has not been evaluated. The purpose of this study was to determine the risk of PAP-induced CDI after selected surgical procedures and to compare such risk before with such risk after the emergence of the hypervirulent strain of C. difficile.Methods. We performed a retrospective cohort study including all patients aged >= 18 years who underwent either abdominal hysterectomy, hip arthroplasty, craniotomy, or colon, cardiac, or vascular surgery from August 1999 through May 2005 in a tertiary care hospital in Quebec, Canada.Results. A total of 8373 surgical procedures were performed, and PAP was used in 7600 of these interventions. Of 98 CDI episodes identified, 40 occurred after patients received PAP only. The risk of CDI was 14.9 cases per 1000 surgical procedures among patients who received PAP only during the period 2003-2005, compared with 0.7 cases per 1000 surgical procedures during the period 1999-2002 (P