title: Prevalence and management of antibiotic associated diarrhea in general hospitals.
abstract: BACKGROUND
  Antibiotic-associated diarrhea (AAD) is a common adverse effect of antibiotic (AB) treatment. This study aimed to measure the overall prevalence of AAD (including mild to moderate diarrhea) in hospitalized AB treated patients, to investigate associated risk factors and to document AAD associated diagnostic investigations, contamination control and treatment.
  
  
  METHODS
  During 8 observation days (with time delay of 10-14 days between each observation day), all adult patients hospitalized at an internal medicine ward of 4 Belgian participating hospitals were screened for AB use. Patients receiving AB on the observation day were included in the study and screened for signs and symptoms of AAD using a period prevalence methodology. Clinical data were collected for all AB users and AAD related investigations and treatment were collected for the entire duration of AAD. Additionally, nurses noted daily the frequency of all extra care associated to the treatment of the diarrhea.
  
  
  RESULTS
  A total of 2543 hospitalized patients were screened of which 743 were treated with AB (29.2%). Included AB users had a mean age of 68 yr (range 16-99) and 52% were male. Penicillins were mostly used (63%) and 19% received more than one AB. AAD was observed in 9.6% of AB users including 4 with confirmed Clostridium difficile infection. AAD started between 1 and 16 days after AB start (median 5) and had a duration of 2 to 41 days (median 4). AAD was significantly associated with higher age and the use of double AB and proton pump inhibitors. AAD patients had extra laboratory investigations (79%), received extra pharmacological treatment (42%) and 10 of them were isolated (14%). AAD related extra nursing time amounted to 51 minutes per day for the treatment of diarrhea.
  
  
  CONCLUSIONS
  In this observational study, with one third of hospitalized patients receiving AB, an AAD period prevalence of 9.6% in AB users was found. AAD caused extra investigations and treatment and an estimated extra nursing care of almost one hour per day. Preventive action are highly recommended to reduce the prevalence of AAD and associated health care costs.
authors.affiliation: Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610, Wilrijk, Antwerp, Belgium. monique.elseviers@uantwerpen.be.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.affiliation: Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610, Wilrijk, Antwerp, Belgium. yoleen@gmail.com.
authors.forename: Yoleen
authors.initials: Y
authors.lastname: Van Camp
authors.affiliation: Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610, Wilrijk, Antwerp, Belgium. sander.naeyaert@telenet.be.
authors.forename: Sander
authors.initials: S
authors.lastname: Nayaert
authors.affiliation: Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, CDE R3.29, Universiteitsplein 1, B-2610, Wilrijk, Antwerp, Belgium. khyra.dure@hotmail.com.
authors.forename: Khyra
authors.initials: K
authors.lastname: Duré
authors.affiliation: Department of Public Health, Interuniversity centre for health economics research (I-CHER), Ghent University, Ghent, Belgium. lieven.annemans@ugent.be.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Hict, Health Economic Services, Brugge, Belgium. ann.tanghe@hict.be.
authors.forename: Ann
authors.initials: A
authors.lastname: Tanghe
authors.affiliation: Hict, Health Economic Services, Brugge, Belgium. sebastian.vermeersch@hict.be.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Vermeersch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins