Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 1908-1915
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1908
Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy
Hong Zhou, Qiang Xu, Yu Liu, Li-Tao Guo
Hong Zhou, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Qiang Xu, Yu Liu, Li-Tao Guo, Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Guo LT designed the study and analyzed the data; all authors contributed to data collection; Zhou H and Xu Q wrote the manuscript; Zhou H and Guo LT revised the manuscript; Liu Y and Guo LT helped select the patients for the study; Zhou H and Xu Q contributed equally to this paper.
Supported by the Clinical Research Award of the First Affiliated Hospital of Xi’ an Jiaotong University, China, No. XJTU1AF-CRF-2018-011; and the Institutional Foundation of the First Affiliated Hospital of Xi’ an Jiaotong University, No. 2018MS-11.
Institutional review board statement: This study was reviewed and approved by the First Affiliated hospital of Xi'an Jiaotong University Ethics committee, No. XJTU1AF2018LSL-011.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no competing financial interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Tao Guo, MD, PhD, Director, Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, China. glt2002@xjtu.edu.cn
Received: February 19, 2020
Peer-review started: February 19, 2020
First decision: March 18, 2020
Revised: April 9, 2020
Accepted: April 29, 2020
Article in press: April 29, 2020
Published online: May 26, 2020
Processing time: 96 Days and 5.1 Hours
Abstract
BACKGROUND

This study aimed to identify factors associated with antibiotic-associated diarrhea (AAD) in patients in the department of intensive care medicine who received antibiotic monotherapy in order to reduce the incidence of AAD and improve rational use of antibiotics in these patients.

AIM

To report the incidence of AAD and the factors associated with AAD in patients receiving antibiotic monotherapy.

METHODS

The study used a single-center retrospective design. A total of 209 patients were enrolled. Patients were divided into two groups: No-AAD group (without AAD) and AAD group (with AAD). There were 45 cases in the AAD group and 164 cases in the no-AAD group. Clinical data of all patients were collected. Data were analyzed using SPSS (version 18.0), and statistical significance was set at P < 0.05.

RESULTS

The overall incidence of AAD was 21.53%. Age [odds ratio (OR) 1.022, 95% confidence interval (CI): 1.001-1.044, P = 0.040], proton pump inhibitor usage time (OR 1.129, 95%CI: 1.020-1.249, P = 0.019), antibiotic usage time (OR 1.163, 95%CI: 1.024-1.320, P = 0.020), and intensive care unit (ICU) stay time (OR 1.133, 95%CI: 1.041-1.234, P = 0.004) were associated with AAD in ICU patients receiving antibiotic monotherapy. mean ± SD ICU stay time was lower in the no-AAD group (8.49 ± 6.31 vs 15.89 ± 10.69, P < 0.001). However, there was no significant difference in ICU-related mortality rates between the two groups (P = 0.729).

CONCLUSION

Older age, longer ICU stay time, duration of use of proton pump inhibitors, and duration of antibiotic increase the incidence of AAD in ICU patients receiving antibiotic monotherapy.

Keywords: Diarrhea; Intensive care unit; Critically ill; Mortality; Antibiotics; Monotherapy

Core tip: In this retrospective study, clinical data were retrospectively analyzed in patients hospitalized at the First Affiliated Hospital of Xi’an Jiaotong University. Factors related to antibiotic-associated diarrhea (AAD) were analyzed in critically ill patients receiving antibiotic monotherapy. The total incidence of AAD was 21.53%. Patients with AAD had a longer intensive care unit (ICU) stay time than patients without AAD (15.89 ± 10.69 vs 8.49 ± 6.31, P < 0.001). Older age, longer ICU stay time, duration of use of proton pump inhibitors and duration of antibiotic increase the incidence of AAD in ICU patients receiving antibiotic monotherapy.