Article
Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients

https://doi.org/10.1016/0196-6553(95)90060-8Get rights and content

Abstract

Background: Nosocomial diarrhea is a common problem in hospitals, but the epidemiology, causes, and consequences of infectious and iatrogenic nosocomial diarrhea are rarely documented in follow-up or surveillance studies of nosocomial infections. The objective of this study was to describe the epidemiology of nosocomial diarrhea in a cohort study of hospitalized patients.

Methods: The setting was a general medicine ward with a total of 30 beds in private or semiprivate rooms in a county hospital. A prospective cohort study of all consenting patients in the study ward was performed during an 11-month period. Patients were interviewed and cultures were obtained to check for stool pathogens within 48 hours of admission, and patients were followed up during their stay in the study ward. Data from medical notes, laboratory tests, antibiotic logs, and patient interviews were collected daily.

Results: Among the 382 eligible patients, nosocomial diarrhea developed in 126 (32.9%): 37 cases were of infectious origin, 57 were iatrogenic, and 32 were of unknown origin. The most common causes of nosocomial diarrhea were Clostridium difficile and antibiotic therapy. Multivariate analysis revealed four risk factors for infectious nosocomial diarrhea: age, length of stay, number of antibiotics, and nasogastric tube feedings. Multivariate analysis also revealed four risk factors for iatrogenic nosocomial diarrhea: number of antibiotics, current gastrointestinal conditions, current renal conditions, and recent surgerey. Comorbidity associated with nosocomial diarrhea included increased risk of acquiring another type of nosocomial infection, increased risk of death, and increased length of stay.

Conclusions: Nosocomial diarrhea was found to be common and associated with an additional burden of comorbidity. Analyses indicated different risk factors, depending on the etiology of nosocomial diarrhea (infectious or iatrogenic). Further studies are recommended to document the epidemiology and cost analysis of nosocomial diarrhea in other hospital populations.

References (40)

  • GW Kaatz et al.

    Acquisition of Clostridium difficile from the hospital environment

    Am J Epidemiol

    (1988)
  • TD Cartmill et al.

    Nosocomial diarrhoea due to a single strain of Clostridium difficile: a prolonged outbreak in elderly patients

    Age Ageing

    (1992)
  • SA Yablon et al.

    Clostridium difficile—related disease: evaluation and prevalence among inpatients with diarrhea in two freestanding rehabilitation hospitals

    Arch Phys Med Rehabil

    (1993)
  • SJ Bachrach

    Successful treatment of an institutional outbreak of shigellosis

    Clin Pediatr

    (1981)
  • A Di Matteo et al.

    Nosocomial outbreak of infant rotavirus diarrhea due to the appearance of a new serotype 4 strain

    J Med Virol

    (1989)
  • S Ratnam et al.

    A nosocomial outbreak of diarrheal disease due to Yersinia enterocolitica serotype 0:5, biotype 1

    J Infect Dis

    (1982)
  • S Sarabia-Arce et al.

    Case-control study of Cryptosporidium parvum infection in Peruvian children hospitalized for diarrhea: possible association with malnutrition and nosocomial infection

    Pediatr Infect Dis J

    (1990)
  • ML De la Morena et al.

    Diarrhea associated with Aeromonas species in children in day care centers

    J Infect Dis

    (1993)
  • TMJ Kelly et al.

    Study of diarrhea in critically ill patients

    Crit Care Med

    (1983)
  • S Eriksson et al.

    Medical implications of nosocomial infection with Clostridium difficile

    Scand J Infect Dis

    (1989)

    • Cited by (0)

    View full text
    Copyright © 1995 Published by Mosby, Inc.