EPIDEMIOLOGY OF INFECTIOUS AND IATROGENIC NOSOCOMIAL DIARRHEA IN A COHORT OF GENERAL MEDICINE PATIENTS

被引：102

作者：

MCFARLAND, LV

机构：

[1] Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle

来源：

AMERICAN JOURNAL OF INFECTION CONTROL | 1995年 / 23卷 / 05期

关键词：

D O I：

10.1016/0196-6553(95)90060-8

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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.

引用

页码：295 / 305

页数：11

共 40 条

[1]

Lima, Guerrant, Kaiser, Germanson, Farr, A retrospective cohort study of nosocomial diarrhea as a risk factor for nosocomial infection, J Infect Dis, 161, pp. 948-952, (1990)

[2]

Brown, Talbot, Axelrod, Provencher, Hoegg, Risk factors for Clostridium difficile toxin-associated diarrhea, Infect Control Hosp Epidemiol, 11, pp. 283-290, (1990)

[3]

Nelson, Auerbach, Baltch, Et al., Epidemic Clostridium difficile—associated diarrhea: role of second- and third-generation cephalosporins, Infect Control Hosp Epidemiol, 15, pp. 88-94, (1994)

[4]

Farr, Diarrhea: a neglected nosocomial hazard?, Infect Control Hosp Epidemiol, 12, pp. 343-344, (1991)

[5]

Testore, Pantosti, Cerquetti, Babudieri, Panichi, Gianfrilli, Evidence for cross-infection in an outbreak of Clostridium difficile—associated diarrhoea in a surgical unit, J Med Microbiol, 26, pp. 125-128, (1988)

[6]

Kaatz, Gitlin, Schaberg, Et al., Acquisition of Clostridium difficile from the hospital environment, Am J Epidemiol, 127, pp. 1289-1294, (1988)

[7]

Cartmill, Shrimpton, Panigrahi, Et al., Nosocomial diarrhoea due to a single strain of Clostridium difficile: a prolonged outbreak in elderly patients, Age Ageing, 21, pp. 245-249, (1992)

[8]

Bender, Bennett, Laughon, Et al., Is Clostridium difficile endemic in chronic-care facilities?, Lancet, 2, pp. 11-13, (1986)

[9]

McFarland, Diarrhea acquired in the hospital, Gastroenterol Clin North Am, 22, pp. 563-577, (1993)

[10]

Yablon, Krotenberg, Fruhmann, Clostridium difficile—related disease: evaluation and prevalence among inpatients with diarrhea in two freestanding rehabilitation hospitals, Arch Phys Med Rehabil, 74, pp. 9-13, (1993)

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