Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
J Gastroenterol Hepatol. 2021 Sep;36(9):2441-2447. doi: 10.1111/jgh.15484. Epub 2021 Mar 20.
Clostridium difficile-associated diarrhea (CDAD) and enteral nutrition (EN)-associated diarrhea are the most common recognized etiologies of nosocomial diarrhea. However, in clinical practice, the data regarding how each etiology contributes to the diarrheal episodes are limited. We identify the causes and factors associated with post-feeding diarrhea.
Using the data of patients enrolled in "Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube-Fed Patients: A Prospective, Randomized, and Controlled Trial", the randomized controlled trial showed no difference in diarrheal incidences between fiber-added and fiber-free formulas. Hence, we analyzed the data of all enrolled patients. The causes of diarrhea were classified according to pre-specified definitions. The factors associated with diarrhea were analyzed using logistic regression.
Diarrhea was found in 37.3% (n = 31/83). The most common cause was medication associated (61.3%). CDAD and EN-associated diarrhea were found in only 9.7% and 6.5%, respectively. Patients with baseline albumin <3 g/dL and underlying cerebrovascular disease were more likely to develop diarrhea (adjusted odds ratio 5.70, 95% confidence interval 1.79-20.51, and adjusted odds ratio 10.83, 95% confidence interval 2.96-48.57, respectively). Compared with those without diarrhea, the length of hospital stay in CDAD patients was significantly longer (+23.1 days, P = 0.02), a trend of longer hospital stay in patients with diarrhea from other causes was observed (+3.2 days, P = 0.096).
Our study found that the most common cause of post-feeding diarrhea is medication associated. Review and cessation of possible drugs should be undertaken before EN modification. CDAD accounts for <10% of diarrhea causes, but it impacts the clinical outcome and should be identified and treated properly.
艰难梭菌相关性腹泻（CDAD）和肠内营养（EN）相关性腹泻是医院获得性腹泻最常见的公认病因。然而，在临床实践中，关于每种病因导致腹泻发作的具体数据有限。本研究旨在确定喂养后腹泻的病因和相关因素。
使用“车前子纤维补充对肠内管饲患者腹泻发生率的影响：一项前瞻性、随机、对照试验”中入组患者的数据，该随机对照试验显示纤维添加配方与纤维无添加配方的腹泻发生率无差异。因此，我们分析了所有入组患者的数据。根据预先规定的定义对腹泻的病因进行分类。采用 logistic 回归分析腹泻的相关因素。
37.3%（n=31/83）的患者出现腹泻。最常见的病因是药物相关（61.3%）。仅发现 9.7%和 6.5%的患者分别为 CDAD 和 EN 相关性腹泻。基线白蛋白<3g/dL 和存在脑血管疾病的患者更容易发生腹泻（调整后的优势比 5.70，95%置信区间 1.79-20.51 和调整后的优势比 10.83，95%置信区间 2.96-48.57）。与无腹泻的患者相比，CDAD 患者的住院时间明显更长（+23.1 天，P=0.02），其他病因腹泻患者的住院时间也有延长的趋势（+3.2 天，P=0.096）。
本研究发现，喂养后腹泻最常见的病因是药物相关。在进行 EN 调整之前，应审查并停止可能的药物。CDAD 占腹泻病因的<10%，但其对临床结局有影响，应正确识别和治疗。
