title: Clostridium difficile in cardiac surgery: risk factors and impact on postoperative outcome.
abstract: 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.
authors: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. crabtreet@wustl.edu
authors: Traves
authors: T
authors: Crabtree
authors: Doug
authors: D
authors: Aitchison
authors: Bryan F
authors: BF
authors: Meyers
authors: Heidi
authors: H
authors: Tymkew
authors: Jennifer R
authors: JR
authors: Smith
authors: Tracey J
authors: TJ
authors: Guthrie
authors: Nabil
authors: N
authors: Munfakh
authors: Marc R
authors: MR
authors: Moon
authors: Michael K
authors: MK
authors: Pasque
authors: Jennifer
authors: J
authors: Lawton
authors: Nader
authors: N
authors: Moazami
authors: Ralph J
authors: RJ
authors: Damiano
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents