Zaidi M, Ponce de León S, Ortiz R M, Ponce de León S, Calva J J, Ruiz-Palacios G, Camorlinga M, Cervantes L E, Ojeda F
Department of Infectious Diseases, Instituto Nacional de la Nutrición, Salvador Zubirán, Mexico City, Mexico.
Infect Control Hosp Epidemiol. 1991 Jun;12(6):349-55. doi: 10.1086/646355.
To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.
Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.
Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.
Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.
Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p less than .01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/H2-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.
Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality. The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.
了解成人医院获得性腹泻的发病率、病因、危险因素、发病率及死亡率。
嵌套病例对照研究，按科室、住院时间、入院日期以及白细胞减少症和/或获得性免疫缺陷综合征（AIDS）的有无进行匹配。病例为发生医院获得性腹泻的患者。对照为在比较期及随后十天内未发生医院获得性腹泻的患者。对粪便样本进行处理以查找寄生虫、酵母菌、细菌和轮状病毒。
墨西哥城的一家三级转诊中心，负责普通内科和外科疾病。
符合条件的受试者为1987年11月至1988年9月期间所有新入院的患者。排除标准为存在慢性腹泻病或黑便。共有115例病例和111例对照。
发生医院获得性腹泻的总体风险为5.5%，即每100患者周发生1.8次发作。59%的病例中发现了潜在病原体。酵母菌和溶组织内阿米巴是最常分离出的病原体。病例的死亡率为18%，而对照的死亡率为5%（p<0.01）。多变量分析显示肠内营养、近期灌肠、念珠菌属的存在、使用抗酸剂/H2受体阻滞剂以及鼻胃管的存在是医院获得性腹泻的重要危险因素。
腹泻是住院患者常见的并发症。其发生频率比以前怀疑的更高，且与相当高的死亡率相关。病原体谱与儿科医院报告的不同。鉴于医院获得性腹泻至少可能是疾病严重程度的一个指标，在综合医院应给予更多关注。
