Abstract
BackgroundClostridioides difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. There is little available data regarding risk factors of CDI for patients who undergo cardiac surgery. The study evaluated the course of CDI in patients after cardiac surgery.MethodsOf 6,198 patients studied, 70 (1.1%) developed CDI. The control group consisted of 73 patients in whom CDI was excluded. Perioperative data and clinical outcomes were analyzed.ResultsPatients with CDI were significantly older in comparison to the control group (median age 73.0 vs 67.0, P = 0.005) and more frequently received proton pump inhibitors, statins, β-blockers and acetylsalicylic acid before surgery (P = 0.008, P = 0.012, P = 0.004, and P = 0.001, respectively). In addition, the presence of atherosclerosis, coronary disease and history of malignant neoplasms correlated positively with the development of CDI (P = 0.012, P = 0.036 and P = 0.05, respectively). There were no differences in the type or timing of surgery, aortic cross-clamp and cardiopulmonary bypass time, volume of postoperative drainage and administration of blood products between the studied groups. Relapse was more common among overweight patients with high postoperative plasma glucose or patients with higher C-reactive protein during the first episode of CDI, as well as those with a history of coronary disease or diabetes mellitus (P = 0.005, P = 0.030, P = 0.009, P = 0.049, and P = 0.025, respectively). Fifteen patients died (21.4%) from the CDI group and 7 (9.6%) from the control group (P = 0.050). Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05, P = 0.041, P = 0.004 and P = 0.007, respectively).ConclusionsThe study did not reveal any specific cardiac surgery-related risk factors for development of CDI.
Highlights
Clostridioides difficile (CD) is widely spread in the human environment and present in about 7–18% of the adult population (Donskey, Kundrapu & Deshpande, 2015)
Patients with Clostridioides difficile infection (CDI) were significantly older in comparison to the control group
There was no correlation between gender and incidence of CDI (P = 0.595)
Summary
Clostridioides difficile (CD) is widely spread in the human environment and present in about 7–18% of the adult population (Donskey, Kundrapu & Deshpande, 2015). Patients who undergo surgery present additional risks for CDI associated with catheter-related infections, prolonged mechanical ventilation, extensive blood product usage, indwelling catheter drainage and open cavities (Gelijns et al, 2014). There have only been a few reports investigating the risk of CDI in patients after heart procedures (Gelijns et al, 2014; Vondran et al, 2018; Flagg et al, 2014; Kirkwood et al, 2018) This prompted us to evaluate the prevalence of hospital-acquired CDI after cardiac surgery, identify patient characteristics and detect risk factors for CDI. Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05,P = 0.041,P = 0.004 and P = 0.007, respectively). The study did not reveal any specific cardiac surgery-related risk factors for development of CDI
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