Department of Pediatric Infectious Diseases and Pediatric Hepatology, John Paul II Hospital, Krakow, Poland.
Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland.
PLoS One. 2021 Mar 17;16(3):e0248512. doi: 10.1371/journal.pone.0248512. eCollection 2021.
It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery. We hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures.
Of the 12,235 analyzed patients following cardiac surgery, 143 (1.2%) developed CDI. The control group included 200 consecutive patients without diarrhea, who underwent cardiac procedure within the same period of observation. Pre-, intra and post-operative levels of blood gases, as well as lactate and glucose concentrations were determined. Postoperatively, arterial blood was drawn four times: immediately after surgery and successively; 4, 8 and 12 h following the procedure.
Baseline pH was lower and PaO2 was higher in CDI patients (p < 0.001 and p = 0.001, respectively). Additionally, these patients had greater base deficiency at each of the analyzed time points (p < 0.001, p = 0.004, p = 0.012, p = 0.001, p = 0.016 and p = 0.001, respectively). Severe hyperlactatemia was also more common in CDI patients; during the cardiac procedure, 4 h and 12 h after surgery (p = 0.027, p = 0.004 and p = 0.001, respectively). Multivariate logistic regression analysis revealed that independent risk factors for CDI following cardiac surgery were as follows: intraoperative severe hyperlactatemia (OR 2.387, 95% CI 1.155-4.933, p = 0.019), decreased lactate clearance between values immediately and 12 h after procedure (OR 0.996, 95% CI 0.994-0.999, p = 0.013), increased age (OR 1.045, 95% CI 1.020-1.070, p < 0.001), emergent surgery (OR 2.755, 95% CI 1.565-4.848, p < 0.001) and use of antibiotics other than periprocedural prophylaxis (OR 2.778, 95% CI 1.690-4.565, p < 0.001).
This study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery.
围手术期酸碱平衡紊乱是否会影响艰难梭菌感染（CDI）尚不清楚，CDI 是心脏手术后的第三大常见主要感染。我们假设围手术期酸碱异常，包括乳酸紊乱，可能预测心脏手术后患者 CDI 的发病概率。
在 12235 例接受心脏手术后的患者中，有 143 例（1.2%）发生 CDI。对照组包括 200 例连续接受心脏手术且无腹泻的患者，观察期间在同一时期进行。测定术前、术中和术后的血气以及乳酸和葡萄糖浓度。术后四次抽取动脉血：术后即刻，然后依次在术后 4、8 和 12 小时。
CDI 患者的基础 pH 值较低，PaO2 较高（p<0.001 和 p=0.001）。此外，这些患者在每个分析时间点的基础不足均更大（p<0.001，p=0.004，p=0.012，p=0.001，p=0.016 和 p=0.001）。CDI 患者也更常见严重的高乳酸血症；在心脏手术期间、术后 4 小时和 12 小时（p=0.027，p=0.004 和 p=0.001）。多变量逻辑回归分析显示，心脏手术后 CDI 的独立危险因素如下：术中严重高乳酸血症（OR 2.387，95%CI 1.155-4.933，p=0.019），手术期间和术后 12 小时乳酸清除率降低（OR 0.996，95%CI 0.994-0.999，p=0.013），年龄增加（OR 1.045，95%CI 1.020-1.070，p<0.001），紧急手术（OR 2.755，95%CI 1.565-4.848，p<0.001）和使用除围手术期预防措施之外的抗生素（OR 2.778，95%CI 1.690-4.565，p<0.001）。
本研究首次表明，围手术期高乳酸血症和乳酸清除率降低可能是心脏手术后 CDI 发生的预测因素。
