Katherine A Kirkwood1, Brian C Gulack2, Alexander Iribarne3, Michael E Bowdish4, Giampaolo Greco5, Mary Lou Mayer6, Karen O'Sullivan5, Annetine C Gelijns7, Nishit Fumakia8, Ravi K Ghanta9, Jesse M Raiten10, Anuradha Lala11, Joseph S Ladowski12, Eugene H Blackstone13, Michael K Parides1, Alan J Moskowitz5, Keith A Horvath14. 1. International Center for Health Outcomes and Innovation Research (InCHOIR) and Center for Biostatistics in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Health, Durham, NC. 3. Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 4. Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif. 5. International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 6. Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. 7. International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: annetine.gelijns@mssm.edu. 8. Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada. 9. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex. 10. Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pa. 11. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, New York, NY. 12. Indiana Ohio Heart, Fort Wayne, Ind. 13. Cardiothoracic Research, Cleveland Clinic, Cleveland, Ohio. 14. Clinical Transformation, Association of American Medical Colleges, Washington, DC.
Abstract
OBJECTIVES: The incidence and severity of Clostridium difficile infection (CDI) have increased rapidly over the past 2 decades, particularly in elderly patients with multiple comorbidities. This study sought to characterize the incidence and risks of these infections in cardiac surgery patients. METHODS: A total of 5158 patients at 10 Cardiothoracic Surgical Trials Network sites in the US and Canada participated in a prospective study of major infections after cardiac surgery. Patients were followed for infection, readmission, reoperation, or death up to 65 days after surgery. We compared clinical and demographic characteristics, surgical data, management practices, and outcomes for patients with CDI and without CDI. RESULTS: C difficile was the third most common infection observed (0.97%) and was more common in patients with preoperative comorbidities and complex operations. Antibiotic prophylaxis for >2 days, intensive care unit stay >2 days, and postoperative hyperglycemia were associated with increased risk of CDI. The median time to onset was 17 days; 48% of infections occurred after discharge. The additional length of stay due to infection was 12 days. The readmission and mortality rates were 3-fold and 5-fold higher, respectively, in patients with CDI compared with uninfected patients. CONCLUSIONS: In this large multicenter prospective study of major infections following cardiac surgery, CDI was encountered in nearly 1% of patients, was frequently diagnosed postdischarge, and was associated with extended length of stay and substantially increased mortality. Patients with comorbidities, longer surgery time, extended antibiotic exposure, and/or hyperglycemic episodes were at increased risk for CDI.
OBJECTIVES: The incidence and severity of Clostridium difficile infection (CDI) have increased rapidly over the past 2 decades, particularly in elderly patients with multiple comorbidities. This study sought to characterize the incidence and risks of these infections in cardiac surgery patients. METHODS: A total of 5158 patients at 10 Cardiothoracic Surgical Trials Network sites in the US and Canada participated in a prospective study of major infections after cardiac surgery. Patients were followed for infection, readmission, reoperation, or death up to 65 days after surgery. We compared clinical and demographic characteristics, surgical data, management practices, and outcomes for patients with CDI and without CDI. RESULTS: C difficile was the third most common infection observed (0.97%) and was more common in patients with preoperative comorbidities and complex operations. Antibiotic prophylaxis for >2 days, intensive care unit stay >2 days, and postoperative hyperglycemia were associated with increased risk of CDI. The median time to onset was 17 days; 48% of infections occurred after discharge. The additional length of stay due to infection was 12 days. The readmission and mortality rates were 3-fold and 5-fold higher, respectively, in patients with CDI compared with uninfected patients. CONCLUSIONS: In this large multicenter prospective study of major infections following cardiac surgery, CDI was encountered in nearly 1% of patients, was frequently diagnosed postdischarge, and was associated with extended length of stay and substantially increased mortality. Patients with comorbidities, longer surgery time, extended antibiotic exposure, and/or hyperglycemic episodes were at increased risk for CDI.
Authors: Jackrapong Bruminhent; Kelly A Cawcutt; Charat Thongprayoon; Tanya M Petterson; Walter K Kremers; Raymund R Razonable Journal: Clin Transplant Date: 2017-04-17 Impact factor: 2.863
Authors: Anthony Lemaire; Viktor Dombrovskiy; George Batsides; Peter Scholz; Al Solina; Nicholas Brownstone; Alan Spotnitz; Leonard Y Lee Journal: Surg Infect (Larchmt) Date: 2014-11-17 Impact factor: 2.150
Authors: Brian T Bateman; Jeremy A Rassen; Sebastian Schneeweiss; Katsiaryna Bykov; Jessica Myers Franklin; Joshua J Gagne; Jennifer M Polinski; Jun Liu; Alexander Kulik; Michael A Fischer; Niteesh K Choudhry Journal: J Thorac Cardiovasc Surg Date: 2013-03-28 Impact factor: 5.209
Authors: Saumeth Cardona; Francisco J Pasquel; Maya Fayfman; Limin Peng; Sol Jacobs; Priyathama Vellanki; Jeff Weaver; Michael Halkos; Robert A Guyton; Vinod H Thourani; Guillermo E Umpierrez Journal: J Diabetes Complications Date: 2017-01-20 Impact factor: 2.852
Authors: Saif A Musa; Carl Moran; Sam J Thomson; Matthew L Cowan; Greg McAnulty; Michael Grounds; Tony Manibur Rahman Journal: J Cardiothorac Vasc Anesth Date: 2011-04 Impact factor: 2.628
Authors: Marc Zerey; B Lauren Paton; Amy E Lincourt; Keith S Gersin; Kent W Kercher; B Todd Heniford Journal: Surg Infect (Larchmt) Date: 2007-12 Impact factor: 2.150
Authors: C Aguayo; R Flores; S Lévesque; P Araya; S Ulloa; J Lagos; J C Hormazabal; J Tognarelli; D Ibáñez; P Pidal; O Duery; B Olivares; J Fernández Journal: Epidemiol Infect Date: 2015-02-17 Impact factor: 4.434
Authors: Max W Adelman; Michael H Woodworth; Virginia O Shaffer; Greg S Martin; Colleen S Kraft Journal: Crit Care Med Date: 2021-01-01 Impact factor: 9.296