Evaluation of Risk Factors for a Fulminant Clostridium Difficile Infection After Cardiac Surgery

A Single-center, Retrospective Cohort Study

Maximilian Vondran; Senta Schack; Jens Garbade; Christian Binner; Meinhard Mende; Ardawan Julian Rastan; Michael Andrew Borger; Thomas Schroeter


BMC Anesthesiol. 2018;18(133) 

In This Article


In recent years, the bacterium Clostridium difficile (CD), a gram-positive, spore-forming, anaerobic bacilli that has been known for almost a century, has played an increasingly important role in postoperative infections. There is currently a growing incidence of diarrhea caused by CD, and especially after the administration of antibiotics about 10% to 20% of all diarrheal cases can be attributed to CD.[1] Subclinical colonization with CD is not at all uncommon; for example, it is estimated that up to 80% of children may be affected.[2] This pathogen is the most common cause of nosocomial diarrhea.[3,4] The incidence of CD-associated diarrhea after various surgical procedures varies from 0.3 to 8.4%[5] in the current literature, depending on the surgical cohort investigated, and mild to moderate severity of CD-associated diarrhea translates into a longer hospital stay. A fulminant course, however, with pseudomembranous colitis and severe complications such as toxic megacolon, including intestinal perforation with sepsis and multi-organ failure, significantly increases mortality after surgical procedures.[6] Despite knowledge gained about CD as one of the most important nosocomial pathogens and extensive investigation of its influence on patients in nursing homes, little is known about the incidence and risk factors for the development of a CD infection (CDI) after surgical interventions, especially in cardiac surgery.

Closer inspection reveals that cardiac surgical patients in particular suffer from many of the prerequisites for colonization with CD with regard to the known predisposition factors, including antibiotic prophylaxis, age, diabetes mellitus, renal or cardiac insufficiency, use of blood products, duration of extracorporeal circulation and ischemic period, and length of stay on an intensive care unit (ICU).[5,7–10]

There are a few reports available that address CDI and clinical outcomes following cardiac surgery.[5,8–10] However, there is no study to date that focuses on CDI with a fulminant course. The purpose of this single-center, retrospective study was to identify risk factors for the development of a fulminant CDI after cardiac surgery. Additional attention was given to the clarification of the incidence and mortality of bland and fulminant CDI and the clinical outcomes of the patients during follow-up.