Evaluation of Risk Factors for a Fulminant Clostridium Difficile Infection After Cardiac Surgery: a Single-center, Retrospective Cohort Study

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2018 Sep 28

PMID 30257648

Citations 1

Authors

Maximilian Vondran

Senta Schack

Jens Garbade

Christian Binner

Meinhard Mende

Ardawan Julian Rastan

Michael Andrew Borger

Thomas Schroeter

Affiliations

Soon will be listed here.

Abstract

Background: Clostridium difficile (CD) is the most common pathogen causing nosocomial diarrhea. The clinical presentation ranges from mild diarrhea to severe complications, including pseudomembranous colitis, toxic megacolon, sepsis, and multi-organ failure. When the disease takes a fulminant course, death ensues rapidly in severe and complex cases. Preventive screening or current prophylactic therapies are not useful. Therefore, this study was conducted to detect risk factors for a fulminant CD infection (CDI) in patients undergoing cardiac surgery.

Methods: Between April 1999 and April 2011, a total of 41,466 patients underwent cardiac surgery at our institution. A review of our hospital database revealed 1256 patients (3.0%) with post-operative diarrheal disease who tested positive for CD; these patients comprised the cohort of this observational study. A fulminant CDI occurred in 153 of these patients (12.2%), which was diagnosed on the basis of gastrointestinal complications, e.g. pseudomembranous colitis, and/or the need for post-cardiac surgery laparotomy. Demographic, peri-operative, and survival data were analyzed, and predictors of a fulminant CDI were assessed by binary logistic regression analysis.

Results: The 30-day mortality was 6.1% (n = 77) for the entire cohort, with significantly higher mortality among patients with a fulminant CDI (21.6% vs. 4.0%, p < 0.001). Overall mortality (27.7%, n = 348) was also higher for patients with a fulminant course of the disease (63.4% vs. 22.8%, p < 0.001), and a laparotomy was required in 36.6% (n = 56) of the fulminant cases. Independent predictors of a fulminant CDI were: diabetes mellitus type 2 (OR 1.74, CI 1.15-2.63, p = 0.008), pre-operative ventilation (OR 3.52, CI 1.32-9.35, p = 0.012), utilization of more than 8 units of red blood cell concentrates (OR 1.95, CI 1.01-3.76, p = 0.046) or of more than 5 fresh-frozen plasma units (OR 3.38, CI 2.06-5.54, p < 0.001), and a cross-clamp time > 130 min (OR 1.93, CI 1.12-3.33, p = 0.017).

Conclusions: We identified several independent risk factors for the development of a fulminant CDI after cardiac surgery. Close monitoring of high-risk patients is important in order to establish an early onset of therapy and thus to prevent a CDI from developing a fulminant course after cardiac surgery.

Citing Articles

infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes-retrospective study.

Rzucidlo-Hymczak A, Hymczak H, Olechowska-Jarzab A, Gorczyca A, Kapelak B, Drwila R PeerJ. 2020; 8:e9972.

PMID: 33062429 PMC: 7531357. DOI: 10.7717/peerj.9972.

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