Crabtree Traves, Aitchison Doug, Meyers Bryan F, Tymkew Heidi, Smith Jennifer R, Guthrie Tracey J, Munfakh Nabil, Moon Marc R, Pasque Michael K, Lawton Jennifer, Moazami Nader, Damiano Ralph J
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Ann Thorac Surg. 2007 Apr;83(4):1396-402. doi: 10.1016/j.athoracsur.2006.10.067.
Clostridium difficile-associated diarrhea (CDAD) is a potentially preventable and often troublesome gastrointestinal complication after cardiac surgery.
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.
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).
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.
艰难梭菌相关性腹泻(CDAD)是心脏手术后一种潜在可预防且常令人困扰的胃肠道并发症。
对1997年1月至2004年8月期间两家机构的8405例心脏手术患者进行回顾性研究。记录术前心脏危险因素、围手术期因素,包括血液制品输注、抗生素使用以及术后发病率和死亡率。对艰难梭菌患者与按手术日期和机构匹配的对照组进行单因素和多因素分析。
8405例患者中有66例被鉴定为毒素阳性的CDAD,总体发病率为0.79%(机构A为0.70%,机构B为1.09%),2003年6月总体发病率峰值为5.45%。多因素分析显示,CDAD的独立预后因素包括年龄增长(优势比[OR]1.028,95%置信区间[CI]:1.001至1.056;p = 0.034)、女性(OR 2.026,95%CI:1.102至3.722;p = 0.022)、血液制品输注(OR 3.277,95%CI:1.292至8.311;p = 0.006)以及抗生素累计使用天数增加(OR 1.046,95%CI:1.014至1.080;p = 0.004)。两组间氟喹诺酮类、头孢菌素类或青霉素衍生物的使用比例无差异。CDAD的诊断与机械通气中位时间延长(25小时对12小时,p < 0.001)、重症监护病房停留时间延长(5天对2天,p < 0.001)和住院时间延长(21天对7天,p < 0.001)相关,30天死亡率无差异(7.6%对9.5%,p = 0.80)。
尽管CDAD的总体发病率较低,但输血方式和抗生素使用的改变可能会影响心脏手术患者中CDAD的发生。