A RETROSPECTIVE EVALUATION OF THE INCIDENCE AND RISK FACTORS OF NOSOCOMIAL DIARRHEA IN CRITICALLY ILL ADULT PATIENTS

MUSTAFA OZGUR*, NERMIN KELEBEK GIRGIN*, HALIS AKALIN, REMZI ISCIMEN**, MELDA SINIRTAS**, FERDA KAHVECI***

*Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation, Bursa, Turkey -**Uludag University, School of Medicine, Department of Microbiology and Infectious Disease, Bursa - ***Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation, Bursa, Turkey

Introduction: Diarrhea is a commonly encountered complication in critically ill patients. It causes fluid and electrolyte loss, increases the workload of nurses, and prolongs the duration of hospitalization. The aim of this retrospective study was to investigate the incidence and risk factors associated with nosocomial diarrhea in adult patients treated in intensive care unit (ICU).

Materials and methods: Records of 786 adult patients treated in the ICU between January 2004 and May 2009 were inspected retrospectively. Loose or watery stools occurring three times a day and more was considered as diarrhea. The control group included those patients who were treated in ICU at the same time as the patients with diarrhea, with similar demographic and clinic features.

Results: It was established that of 786 patients, 78 (9.92%) developed diarrhea. The time lapse between admission to the ICU and the onset of diarrhea was 12.4±21.7 days, and the duration of diarrhea was 4.38±2.13 days. Compared to the controls (n=80), the rate of enteral feeding was higher in patients with diarrhea, enteral nutrition products of high concentration, proton pump inhibitors, medications containing sorbitol and Mg+2, clindamycin, and cephalosporins were used significantly more often (p=0.002, p=0.006, p=0.048, p=0.006, p=0.033, p=0.048). Furthermore, the length of stay in ICU was longer in these patients (p=0.043). Clostridium difficile toxin was determined to be positive in 11 patients with diarrhea (14.1%). These cases were older and had a longer ICU stay and duration of diarrhea (p=0.031, p=0.027, p=0.004).

Conclusion: It was found that the patients with diarrhea had a high enteral nutrition infusion rate, and products concentration, a high level of drug usage such as proton pump inhibitors, antibiotics, and sorbitol, and a low albumin level. Nosocomial diarrhea could also prolong the length of ICU stay in critically ill patients.