Clostridium difficile infection after cardiac surgery: Prevalence, morbidity, mortality, and resource utilization

Objective Despite increasing efforts to prevent infection, the prevalence of hospital-associated Clostridium difficile infections (CDI) is increasing. Heightened awareness prompted this study of the prevalence and morbidity associated with CDI after cardiac surgery.

Results One hundred forty-five patients (0.63%) tested positive for CDI at a median of 9 days postoperatively, 135 by enzyme immunoassay and 11 by PCR. Its prevalence more than doubled over the study period. Seventy-seven patients (48%) were transfers from outside hospitals. Seventy-three patients (50%) were exposed preoperatively to antibiotics and 79 (56%) to proton-pump inhibitors. Patients with CDI had more baseline comorbidities, more reoperations, and received more blood products than patients who did not have CDI. Presenting symptoms included diarrhea (107; 75%), distended abdomen (48; 34%), and abdominal pain (27; 19%). All were treated with metronidazole or vancomycin. Sixteen patients (11%) died in hospital, including 5 of 10 who developed toxic colitis; 3 of 4 undergoing total colectomy survived. Among matched patients, those with CDI had more septicemia (P <.0001), renal failure (P =.0002), reoperations (P <.0001), prolonged postoperative ventilation (P <.0001), longer hospital stay (P <.0001), and lower 3-year survival, 52% versus 64% (P =.03), than patients who did not have CDI.

Conclusions Although rare, the prevalence of CDI is increasing, contributing importantly to morbidity and mortality after cardiac surgery. If toxic colitis develops, mortality is high, but colectomy may be lifesaving.