Researchers Examine Prevalence and Management of Antibiotic-Associated Diarrhea in General Hospitals

Antibiotic-associated diarrhea (AAD) is a common adverse effect of antibiotic treatment. The study by Elseviers, et al. (2015) aimed to measure the overall prevalence of AAD (including mild to moderate diarrhea) in hospitalized antibiotic-treated patients, to investigate associated risk factors and to document AAD associated diagnostic investigations, contamination control and treatment.

During eight observation days (with time delay of 10 to 14 days between each observation day), all adult patients hospitalized at an internal medicine ward of four Belgian participating hospitals were screened for antibiotic use. Patients receiving antibiotics on the observation day were included in the study and screened for signs and symptoms of AAD using a period prevalence methodology. Clinical data were collected for all antibioti users and AAD related investigations and treatment were collected for the entire duration of AAD. Additionally, nurses noted daily the frequency of all extra care associated to the treatment of the diarrhea.

A total of 2,543 hospitalized patients were screened of which 743 were treated with antibiotics (29.2 percent). Included antibiotic users had a mean age of 68 years (range 16-99) and 52 percent were male. Penicillins were mostly used (63 percent) and 19 percent received more than one antibiotic. AAD was observed in 9.6 percent of antibiotic users including four with confirmed Clostridium difficile infection. AAD started between 1 and 16 days after antibiotic start (median 5) and had a duration of 2 to 41 days (median 4). AAD was significantly associated with higher age and the use of double antibiotic and proton pump inhibitors. AAD patients had extra laboratory investigations (79 percent), received extra pharmacological treatment (42 percent) and 10 of them were isolated (14 percent). AAD related extra nursing time amounted to 51 minutes per day for the treatment of diarrhea.

In this observational study, with one-third of hospitalized patients receiving AB, an AAD period prevalence of 9.6 percent in antibiotic users was found. AAD caused extra investigations and treatment and an estimated extra nursing care of almost one hour per day. The researchers say preventive actions are highly recommended to reduce the prevalence of AAD and associated healthcare costs. Their research was published in BMC Infectious Diseases.

Reference: Elseviers MM, Van Camp Y, Nayaert S, Duré K, Annemans L, Tanghe A and Vermeersch S. Prevalence and management of antibiotic associated diarrhea in general hospitals. BMC Infectious Diseases 2015, 15:129  doi:10.1186/s12879-015-0869-0

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