Risk Factors for Antibiotic-Associated Diarrhea in Critically Ill Patients

Abstract

BackgroundWe analyzed the factors related to AAD to inform the rational use of antibiotics in critically ill patients and to reduce the incidence of AAD by providing a reference for antibiotic use in the clinical setting.Material/MethodsThis study was a retrospective analysis of the clinical data of patients who were hospitalized in the ICU of the First Teaching Hospital of Xi’an Jiaotong University from January 1, 2015 to December 31, 2016. Patients with AAD were assigned to the case group, and all others were assigned to the control group. Basic data were collected for all the selected patients. All the relevant data were analyzed with univariate or multivariate regression analyses, and P<0.05 was considered statistical significance.ResultsA total of 293 patients were enrolled. Statistical analyses showed that gender (OR 1.915; 95% [CI] 1.061–3.455; P=0.031), parenteral nutrition (OR 1.877; 95% [CI] 1.043–3.377; P=0.036), preventive use of probiotics (OR 0.497; 95% [CI] 0.285–0.866; P=0.014), APACHE II score upon admission to the ICU (OR 0.961; 95% [CI] 0.927–0.998; P=0.037) and use of enzyme-inhibitor antibiotics (OR 1.899; 95% [CI] 1.044–3.420; P=0.016) were associated with AAD. Further subgroup analysis by gender showed that parenteral nutrition (OR 2.144; 95% [CI] 1.064–4.322; P=0.033), preventive use of probiotics (OR 0.367; 95% [CI] 0.186–0.722; P=0.004), and APACHE II score upon admission to the ICU (OR 1.055; 95% [CI] 1.011–1.101; P=0.014) were associated with AAD in critically ill male patients. Age (OR 0.975; 95% [CI] 0.951–0.999; P=0.041) and use of carbapenem antibiotics (OR 4.826; 95% [CI] 1.011–23.030; P=0.048) were associated with AAD in critically ill female patients.ConclusionsParenteral nutrition, prophylactic use of probiotics, use of enzyme-inhibitor antibiotics, and use of combinations of antibiotics were associated with AAD in critically ill patients. The prophylactic use of probiotics may be a protective factor in AAD.

Factors related to antibiotic-associated diarrhea in patients in the intensive care unit receiving antifungals: a single-center retrospective study

“…3,5,28,29 AAD is especially more likely to occur when these are combined with other antibiotics. 2 Our study showed that the use of azithromycin and enzyme inhibitors was associated with AAD in ICU patients receiving antifungals, which is consistent with the literature. 2 Our study also showed that the antifungal treatment time was associated with AAD in ICU patients.…”

“…13,16 The duration of ICU admission (17.88 ± 11.11 vs. 9.44 ± 6.68 days) was significantly lower in the no AAD group (P < 0.001), indicating that the occurrence of AAD could prolong the duration of ICU admission of critically ill patients. However, there was no significant difference in mortality between these two groups, and although this is consistent with our previous study, 2 it is not consistent with previous reports in the literature. This may be influenced by specific customs in different parts of China; for example, in rural areas around Shaanxi, many families request discharge of critically ill patients while they are still alive.…”

“…Antibiotic-associated diarrhea (AAD) is a syndrome of disrupted intestinal flora that is caused by antibiotic administration and cannot be explained by other causes of diarrhea. 1,2 It is a general term for a disorder of the intestinal flora with diarrhea as the main symptom. The incidence rate of AAD varies from 5% to 35% 3,4 depending on the type of antibiotic and patient demographics.…”

“…10–13 Among patients admitted to the intensive care unit (ICU), the incidence rate is much higher and the condition is more severe. 2,14 Among all patients with AAD, more than 20% experience initial treatment failure and 40% to 60% experience a relapse. 10,15 Therefore, prevention of AAD is essential for patients in the ICU.…”

“…13,16 However, past research focused mainly on the general population; few studies have examined the risk factors for AAD in patients with critical conditions. Our previous studies 2 established that the use of antifungal drugs is related to the occurrence of AAD among patients in the ICU. However, there have been no further studies on how antifungal drugs affect AAD.…”