Prolonged Antibiotic Prophylaxis May Increase CDI Risk After Cardiac Surgery

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Mortality during the 65-day follow-up period was higher in patients with CDI compared with patients without CDI.
Mortality during the 65-day follow-up period was higher in patients with CDI compared with patients without CDI.

A study of major infections following cardiac surgery found Clostridium difficile infection (CDI) in nearly 1% of patients, which led to increased length of stay (LOS) and mortality, according to a study published in Thoracic and Cardiovascular Surgery.

Known risk factors for CDI infections reveal that cardiac surgery patients may be a vulnerable population. However, most studies in this population have focused mainly on surgical site infections. Therefore, a prospective cohort study to identify management practices associated with CDI occurring after cardiac surgery was undertaken.

A total of 5158 patients from 10 sites in the United States and Canada were included and followed up to 65 days post-surgery. CDI was detected in 50 patients (0.97%) in the follow-up period. Median time to diagnosis was 17 days and onset of CDI before discharge occurred in 52% of patients.

Renal failure was the sole significant preoperative risk factor according to multivariable analysis (P =.004). Hyperglycemia, days of postoperative antibiotic prophylaxis, and ICU (LOS) >2 days were all significant risk factors for CDI. CDI infection also resulted in higher readmission and mortality rates.

The results demonstrate a need for taking precautions in individuals with renal failure and patients undergoing procedures requiring longer hospital stays. The researchers caution that the interpretation of increased LOS due to CDI data “do not take into account other potentially informative covariates,” such as index surgical procedures.

Recommended efforts to reduce postoperative CDI infection are “glycemic control and optimal duration of antibiotic prophylaxis <48 hours,” and caregivers should remain vigilant because CDI frequently occurs 2 weeks post-surgery.

Reference

Kirkwood KA, Gulack BC, Iribarne A, et al. A multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis [published online September 28, 2017]. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2017.09.089

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