Prognostic role of perioperative acid-base disturbances on the risk of Clostridioides difficile infection in patients undergoing cardiac surgery.

Anna Rzucidło-Hymczak,Bogusław Kapelak,Anna Kędziora,Rafał Drwiła,Dariusz Plicner,Hubert Hymczak,Robert Jeenchen Chen

doi:10.1371/journal.pone.0248512

Anna Rzucidło-Hymczak, Bogusław Kapelak + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0248512

Copy DOI

Abstract

It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery. We hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures. Of the 12,235 analyzed patients following cardiac surgery, 143 (1.2%) developed CDI. The control group included 200 consecutive patients without diarrhea, who underwent cardiac procedure within the same period of observation. Pre-, intra and post-operative levels of blood gases, as well as lactate and glucose concentrations were determined. Postoperatively, arterial blood was drawn four times: immediately after surgery and successively; 4, 8 and 12 h following the procedure. Baseline pH was lower and PaO2 was higher in CDI patients (p < 0.001 and p = 0.001, respectively). Additionally, these patients had greater base deficiency at each of the analyzed time points (p < 0.001, p = 0.004, p = 0.012, p = 0.001, p = 0.016 and p = 0.001, respectively). Severe hyperlactatemia was also more common in CDI patients; during the cardiac procedure, 4 h and 12 h after surgery (p = 0.027, p = 0.004 and p = 0.001, respectively). Multivariate logistic regression analysis revealed that independent risk factors for CDI following cardiac surgery were as follows: intraoperative severe hyperlactatemia (OR 2.387, 95% CI 1.155-4.933, p = 0.019), decreased lactate clearance between values immediately and 12 h after procedure (OR 0.996, 95% CI 0.994-0.999, p = 0.013), increased age (OR 1.045, 95% CI 1.020-1.070, p < 0.001), emergent surgery (OR 2.755, 95% CI 1.565-4.848, p < 0.001) and use of antibiotics other than periprocedural prophylaxis (OR 2.778, 95% CI 1.690-4.565, p < 0.001). This study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery.

Highlights

Clostridioides difficile (CD) is an anaerobic, Gram-positive bacillus, which may be part of the normal intestinal microbiota in healthy people
It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery
Baseline pH was lower and PaO2 was higher in CDI patients (p < 0.001 and p = 0.001, respectively)

Summary

Introduction

Clostridioides difficile (CD) is an anaerobic, Gram-positive bacillus, which may be part of the normal intestinal microbiota in healthy people. It has been shown that high glucose levels and stress hyperglycemia during the early postoperative period were associated with greater risk for development of CDI in patients following cardiac surgery [7]. It is unclear whether other acid-base disturbances, especially the development of hyperlactatemia in the perioperative period, may impact CDI occurrence. It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery. We hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures

Methods

Results

Conclusion