A multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis

Kirkwood, Katherine; Gulack, Brian C.; Iribarne, Alexander; Bowdish, Michael E.; Greco, Giampaolo; Mayer, Mary Lou; O’Sullivan, Karen; Gelijns, Annetine C.; Fumakia, Nishit; Ghanta, Ravi K.; Raiten, Jesse; Ladowski, Joseph M.; Blackstone, Eugene H.; Parides, Michael K.; Moskowitz, Alan J.; Horvath, Keith A.

doi:10.1016/j.jtcvs.2017.09.089

Cited by 22 publications

(24 citation statements)

References 56 publications

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“…In our study cefazolin, ceftriaxone and fluoroquinolone were the most frequently used antibiotics ( Table 3 ). The relationship between antibiotic treatment and the risk of CDI has also been demonstrated in other studies ( McFarland, Surawicz & Stamm, 1990 ; Eze et al, 2017 ; De Roo & Regenbogen, 2020 ; Furuya-Kanamori et al, 2015a ; Kirkwood et al, 2018 ; Ge et al, 2018 ; Kazakova et al, 2020 ; Jachowicz et al, 2020 ). It should be remembered that any antibiotic may be the cause of CDI, even those used to treat CDI ( McDonald et al, 2018 ).…”

Section: Discussionsupporting

confidence: 74%

“…Patients with CDI more frequently have chronic illnesses (Eze et al, 2017;De Roo & Regenbogen, 2020;Furuya-Kanamori et al, 2015a;Kirkwood et al, 2018). In our study atherosclerosis, ischemic heart disease and history of malignant neoplasms were correlated with CDI.…”

Section: Discussionmentioning

confidence: 57%

“…This finding is consistent with the results of a study by Gelijns et al, who demonstrated the association of hyperglycemia with CDI (Gelijns et al, 2014). Similarly, Kirkwood et al showed that postoperative hyperglycemia was associated with an increased risk of CDI (Kirkwood et al, 2018). Therefore, prevention and treatment of hyperglycemia after cardiac surgery should be taken into consideration.…”

Section: Discussionmentioning

confidence: 97%

“…There is little available data regarding risk factors for CDI among patients who undergo cardiac surgery. There have only been a few reports investigating the risk of CDI in patients after heart procedures ( Gelijns et al, 2014 ; Vondran et al, 2018 ; Flagg et al, 2014 ; Kirkwood et al, 2018 ). This prompted us to evaluate the prevalence of hospital-acquired CDI after cardiac surgery, identify patient characteristics and detect risk factors for CDI.…”

Section: Introductionmentioning

confidence: 99%

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Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

Rzucidło-Hymczak

Hymczak

Olechowska-Jarząb

et al. 2020

PeerJ

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Background Clostridioides difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. There is little available data regarding risk factors of CDI for patients who undergo cardiac surgery. The study evaluated the course of CDI in patients after cardiac surgery. Methods Of 6,198 patients studied, 70 (1.1%) developed CDI. The control group consisted of 73 patients in whom CDI was excluded. Perioperative data and clinical outcomes were analyzed. Results Patients with CDI were significantly older in comparison to the control group (median age 73.0 vs 67.0, P = 0.005) and more frequently received proton pump inhibitors, statins, β-blockers and acetylsalicylic acid before surgery (P = 0.008, P = 0.012, P = 0.004, and P = 0.001, respectively). In addition, the presence of atherosclerosis, coronary disease and history of malignant neoplasms correlated positively with the development of CDI (P = 0.012, P = 0.036 and P = 0.05, respectively). There were no differences in the type or timing of surgery, aortic cross-clamp and cardiopulmonary bypass time, volume of postoperative drainage and administration of blood products between the studied groups. Relapse was more common among overweight patients with high postoperative plasma glucose or patients with higher C-reactive protein during the first episode of CDI, as well as those with a history of coronary disease or diabetes mellitus (P = 0.005, P = 0.030, P = 0.009, P = 0.049, and P = 0.025, respectively). Fifteen patients died (21.4%) from the CDI group and 7 (9.6%) from the control group (P = 0.050). Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05, P = 0.041, P = 0.004 and P = 0.007, respectively). Conclusions The study did not reveal any specific cardiac surgery-related risk factors for development of CDI.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

Rzucidło-Hymczak

Hymczak

Olechowska-Jarząb

et al. 2020

PeerJ

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“…In this case, retrospectively, prolonged postoperative sulbactam/ampicillin administration until POD 7 should not have been done because prolonged antibiotic prophylaxis (> 48 h) is not recommended due to the increasing risk of resistant bacteria and Clostridium difficile infection [5]. This postoperative prophylactic administration resulted in confusion, leading to the difficulty of accurate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Unilateral antibiotic-induced acute eosinophilic pneumonia on the operative side after surgery for primary lung cancer: a case report

2020

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Background: Acute eosinophilic pneumonia (AEP) is a rare idiopathic lung disease characterized by pulmonary eosinophilia. The epidemiology of AEP remains understudied; however, past reports have reported that AEP can be caused by an allergic reaction to medications, such as antibiotics or inhaled antigens, such as tobacco smoke. AEP usually occurs bilaterally. However, we encountered an unusual case of antibiotic-induced eosinophilic pneumonia showing unilateral consolidation just on the operative side, which was initially diagnosed as postoperative bacterial pneumonia and treated with antibiotic therapy. The prescribed antibiotics paradoxically provoked AEP and worsened the patient's condition. Here, we report this antibiotic-induced AEP case showing unilateral consolidation only on the operative side which could be triggered by surgery for primary lung cancer. Case presentation: A 74-year-old man underwent right upper lobectomy for lung adenocarcinoma. On postoperative day (POD) 9, an interstitial shadow appeared in the right lower lung field of the chest radiographs, along with a fever of 38.5°C, dyspnea needing oxygen supplementation, and increased purulent sputum production, suggesting postoperative bacterial pneumonia. Despite administration of the broad-spectrum antibiotic, meropenem, the fever did not improve, and pulmonary opacity gradually worsened. Blood analysis showed increased peripheral eosinophils at 1182/mm 3. The meropenem treatment was discontinued and bronchoscopy was performed for further evaluation, and the bronchoalveolar lavage fluid assessment showed a remarkable increase in the eosinophil population (51%). The drug lymphocyte stimulation test (DLST) for meropenem was positive. We diagnosed the patient with antibiotic-induced unilateral AEP, after which corticosteroid treatment was initiated. The patient subsequently improved and the infiltration in the right lower lung field completely disappeared. The patient was discharged on POD 43 without oxygen supplementation and is doing well without tumor recurrence 16 months after the surgery. Conclusions: Unilateral drug-induced AEP is rare. Nonetheless, it should be recognized as a differential diagnosis of postoperative pneumonia even in cases of a unilateral radiographic infiltration, because the lung operation itself could trigger this type of AEP.

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Prevention and Treatment of Infections

Monedero

Martín

Aldecoa

2020

Anesthesia in Thoracic Surgery

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A multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis

Cited by 22 publications

References 56 publications

Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

Unilateral antibiotic-induced acute eosinophilic pneumonia on the operative side after surgery for primary lung cancer: a case report

Prevention and Treatment of Infections

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