Clostridium difficile infection after orthopedic surgery: Incidence, associated factors, and impact on outcome

Dong Youn Kim, Yu Mi Lee, Ki Ho Park, Young Jin Kim, Kyung Chung Kang, Chang Kyun Lee, Mi Suk Lee

Research output: Contribution to journalArticlepeer-review


Background: To identify the incidence, associated factors, and impact of hospital-acquired Clostridium difficile infection (CDI) among patients who have undergone orthopedic surgery. Methods: We retrospectively reviewed the charts of all adults patients who underwent orthopedic surgery from January 2016 through December 2017 at a tertiary hospital. Results: Of 7,363 patients who underwent orthopedic surgical procedures, 52 (0.7%) developed hospital-acquired CDI. The independent factors associated with CDI were age ≥65 years (adjusted odds ratio [aOR], 3.4; P < .001), preoperative hospital stay ≥3 days (aOR, 3.7; P < .001), operating time ≥3 hours (aOR, 2.5; P < .005), and antibiotic use for infection treatment (aOR, 4.3; P < .001). After adjusting for the timing of CDI using a multistate model, the mean excess LOS attributable to CDI was 2.8 days (95% confidence interval [CI], 0.4-5.3). The impact of CDI on excess LOS was more evident among patients aged ≥65 years (4.4 days; 95% CI, 1.8-7.0) and those with any comorbidity (5.6 days; 95% CI, 3.0-8.1). Conclusions: The overall incidence of CDI after orthopedic surgery was 0.7%. The occurrence of CDI after orthopedic surgery contributes to increased LOS. The greatest impact of CDI on LOS occurs among elderly patients and patients with comorbidities.

Original languageEnglish
Pages (from-to)72-76
Number of pages5
JournalAmerican Journal of Infection Control
Issue number1
Publication statusPublished - Jan 2022


  • Clostridium difficile
  • Economic burden
  • Hospital-acquired infection
  • Length of hospital stay
  • Multistate model


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