Abstract
BackgroundIt is unclear whether acid-base balance disturbances during the perioperative period may impactClostridium difficileinfection (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.MethodsOf 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.ResultsBaseline pH was lower and PaO2was higher in CDI patients (p< 0.001 andp= 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 andp= 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 andp= 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).ConclusionThis study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery.
Funder
John Paul II Hospital, Krakow, Poland
Publisher
Public Library of Science (PLoS)
Cited by
2 articles.
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