Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study
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 fulminan...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-018-0597-2 |
| _version_ | 1811293227603460096 |
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| author | Maximilian Vondran Senta Schack Jens Garbade Christian Binner Meinhard Mende Ardawan Julian Rastan Michael Andrew Borger Thomas Schroeter |
| author_facet | Maximilian Vondran Senta Schack Jens Garbade Christian Binner Meinhard Mende Ardawan Julian Rastan Michael Andrew Borger Thomas Schroeter |
| author_sort | Maximilian Vondran |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T04:57:20Z |
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| id | doaj.art-b0da33cb5c4b446780ad3a4b6a357264 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-13T04:57:20Z |
| publishDate | 2018-09-01 |
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| spelling | doaj.art-b0da33cb5c4b446780ad3a4b6a3572642022-12-22T03:01:26ZengBMCBMC Anesthesiology1471-22532018-09-011811810.1186/s12871-018-0597-2Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort studyMaximilian Vondran0Senta Schack1Jens Garbade2Christian Binner3Meinhard Mende4Ardawan Julian Rastan5Michael Andrew Borger6Thomas Schroeter7University Department for Cardiac Surgery, Heart Center LeipzigUniversity Department for Cardiac Surgery, Heart Center LeipzigUniversity Department for Cardiac Surgery, Heart Center LeipzigUniversity Department for Cardiac Surgery, Heart Center LeipzigCenter for Clinical Trials, University of LeipzigDepartment of Cardiovascular Surgery, Thoracic and Vascular Surgery, University Hospital Marburg (UKGM)University Department for Cardiac Surgery, Heart Center LeipzigUniversity Department for Cardiac Surgery, Heart Center LeipzigAbstract 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.http://link.springer.com/article/10.1186/s12871-018-0597-2Intensive careClostridium difficileCardiac surgeryHigh riskCritical care |
| spellingShingle | Maximilian Vondran Senta Schack Jens Garbade Christian Binner Meinhard Mende Ardawan Julian Rastan Michael Andrew Borger Thomas Schroeter Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study BMC Anesthesiology Intensive care Clostridium difficile Cardiac surgery High risk Critical care |
| title | Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study |
| title_full | Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study |
| title_fullStr | Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study |
| title_full_unstemmed | Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study |
| title_short | Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study |
| title_sort | evaluation of risk factors for a fulminant clostridium difficile infection after cardiac surgery a single center retrospective cohort study |
| topic | Intensive care Clostridium difficile Cardiac surgery High risk Critical care |
| url | http://link.springer.com/article/10.1186/s12871-018-0597-2 |
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