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GASTROENTEROLOGY

Prevalence of Diarrhea at a University Hospital and Association with Modifiable Risk Factors

Assistant Professor, College of Pharmacy, Department of Clinical Sciences and Administration, University of Houston, and St. Luke's Episcopal Hospital, Houston, TX

Gail Graham, RN

Nurse Practitioner, Outcomes Management and Research, St. Luke's Episcopal Hospital

Laura Gerard, PharmD

Clinical Assistant Professor, College of Pharmacy, Department of Clinical Sciences and Administration, University of Houston

Thanh Dao, MT

Infection Control Practitioner, Infection Control Department, St. Luke's Episcopal Hospital

Zhi Dong Jiang, MD PhD

Assistant Professor, The University of Texas School of Public Health, Houston

Margaret Price, PhD

Infection Control Coordinator, Infection Control Department, St. Luke's Episcopal Hospital

Herbert L DuPont, MD

Professor, The University of Texas School of Public Health and Baylor College of Medicine, Houston

Reprints: Dr. Garey, College of Pharmacy, Department of Clinical Sciences and Administration, University of Houston, St. Luke's Episcopal Hospital, 1441 Moursund St., Houston, TX 77030-3047, fax 713/795-8383, kgarey{at}uh.edu

OBJECTIVE: To assess the prevalence of diarrhea at a university-affiliated medical center and the presence of modifiable risk factors.

METHODS: A point prevalence survey was conducted. All patients hospitalized for more than 24 hours were asked if they were experiencing diarrhea. Stools of patients not previously tested were assessed for Clostridium difficile (CD) toxins A and B. Univariate analysis and multivariate logistic regression analyses were used to identify modifiable variables associated with diarrhea (significance defined as p < 0.05).

RESULTS: Four hundred eighty-five hospitalized patients were interviewed, of whom 60 (12.4%) reported 2 or more loose, unformed stools in the last 24 hours. Six of 81 (7.4%) patients tested positive for CD toxin. Three (50%) of the CD toxin-positive patients had not previously been tested during the current admission. Patients with diarrhea were more likely to have tested CD toxin-positive (OR 10.6; p = 0.01), received antibiotics (OR 1.79; p = 0.04), or been hospitalized for a longer period of time (p = 0.04).

CONCLUSIONS: Diarrhea was prevalent in 12.4% of hospitalized patients at a large university hospital at one point in time. Patients with diarrhea were more likely to have CD infection, receive antibiotics, or experience a longer hospitalization. Half of the CD diarrhea cases occurring in the hospital had been previously unidentified. Hospitalized patients should be evaluated for diarrhea on an ongoing basis with appropriate interventions instituted.

Key Words: diarrhea, Clostridium difficile, epidemiology, risk factors

Published Online, May 9, 2006. www.theannals.com, DOI 10.1345/aph.1H028