Poland: The presence of hyperlactatemia and decreased lactate clearance during cardiac surgery may predict the occurrence of Clostridium difficile infection (CDI) post-surgery, finds a recent study in the journal PlosONE.
Whether acid-base balance disturbances during the perioperative period may have an impact on CDI is not clear. CDI is the third most common major infection that occurs after cardiac surgery. Dariusz Plicner, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland, and colleagues hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures.
For the purpose, the researchers analyzed 12,235 patients after cardiac surgery, of which 143 (1.2%) developed CDI. The control group included 200 consecutive patients without diarrhea, who underwent cardiac procedure within the same period of observation.
The researchers determined pre-, intra and post-operative levels of blood gases, as well as lactate and glucose concentrations. Postoperatively, arterial blood was drawn four times: immediately after surgery and successively; 4, 8 and 12 h following the procedure.
Key findings of the study include:
Baseline pH was lower and PaO2 was higher in CDI patients. Additionally, these patients had greater base deficiency at each of the analyzed time points.
· Severe hyperlactatemia was also more common in CDI patients; during the cardiac procedure, 4 h and 12 h after surgery.
· Multivariate logistic regression analysis revealed that independent risk factors for CDI following cardiac surgery were as follows: intraoperative severe hyperlactatemia (OR 2.387), decreased lactate clearance between values immediately and 12 h after procedure (OR 0.996), increased age (OR 1.045), emergent surgery (OR 2.755) and use of antibiotics other than periprocedural prophylaxis (OR 2.778).
"This study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery," wrote the authors.
Reference:
The study titled, "Prognostic role of perioperative acid-base disturbances on the risk of Clostridioides difficile infection in patients undergoing cardiac surgery," is published in the journal PlosOne.
DOI: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.02485