Clostridium difficile in cardiac surgery: risk factors and impact on postoperative outcome.
BACKGROUND
Clostridium difficile-associated diarrhea (CDAD) is a potentially preventable and often troublesome gastrointestinal complication after cardiac surgery.


METHODS
A retrospective study was performed of 8,405 cardiac surgery patients at two institutions between January 1997 and August 2004. Preoperative cardiac risk factors, perioperative factors including blood product transfusion, antibiotic utilization, and postoperative morbidity and mortality were recorded. Univariate and multivariate analyses were performed comparing C. difficile patients with a control group matched by date of surgery and institution.


RESULTS
Sixty-six of the 8,405 patients identified with toxin-positive CDAD produced an overall incidence of 0.79% (0.70% at institution A and 1.09% at institution B), with a peak overall incidence of 5.45% in June 2003. Independent prognostic factors for CDAD by multivariate analysis included advancing age (odds ratio [OR] 1.028, 95% confidence interval [CI]: 1.001 to 1.056; p = 0.034), female sex (OR 2.026, 95% CI: 1.102 to 3.722; p = 0.022), blood product transfusion (OR 3.277, 95% CI: 1.292 to 8.311; p = 0.006), and increasing cumulative days of antibiotic administration (OR 1.046, 95% CI: 1.014 to 1.080; p = 0.004). There were no differences in the proportion of fluoroquinolones, cephalosporins, or penicillin derivatives administered between groups. The diagnosis of CDAD was associated with a greater median length of mechanical ventilation (25 hours versus 12 hours, p < 0.001), longer intensive care unit stay (5 days versus 2 days, p < 0.001), and extended hospital stay (21 days versus 7 days, p < 0.001), with no difference in 30-day mortality (7.6% versus 9.5%, p = 0.80).


CONCLUSIONS
Although the overall incidence of CDAD was low, alteration in transfusion practices and antibiotic utilization may impact the development of CDAD among cardiac surgical patients.
Crabtree
Traves
T
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. crabtreet@wustl.edu
Aitchison
Doug
D
Meyers
Bryan F
BF
Tymkew
Heidi
H
Smith
Jennifer R
JR
Guthrie
Tracey J
TJ
Munfakh
Nabil
N
Moon
Marc R
MR
Pasque
Michael K
MK
Lawton
Jennifer
J
Moazami
Nader
N
Damiano
Ralph J
RJ
D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D011322:Primary Prevention / Q000379:methods; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D000900:Anti-Bacterial Agents