NOSOCOMIAL DIARRHEA

Nosocomial diarrheas are an important problem in hospitals, and in critical care units in particular. Hospital-acquired diarrhea may be on an infectious or noninfectious basis. Common noninfectious causes of nosocomial diarrhea include medication-induced changes in the fecal flora or changes secondary to enteral hyperalimenation. Infectious causes of nosocomial diarrhea are due to enteric pathogens in outbreak situations and virtually all of the causes are due to Clostridium difficile. C. difficile is a resident of the human colon and does not cause disease if its toxins are not elaborated. Chemotherapeutic agents, and more commonly, antibiotics, induce the elaboration of toxin A and B from C. difficile in the distal gastrointestinal tract. The spectrum of disease of C. difficile in hospitalized patients includes asymptomatic carriage to mild watery diarrhea, fulminant and severe diarrhea, and pseudomembranous enterocolitis. The treatment of C. difficile diarrhea is usually with oral metronidazole or vancomycin, and C. difficile colitis is treated with intravenous metronidazole. Infection control measures are necessary to prevent the spread of this sporforming organism within the institution since it is capable of surviving in the hospital environment for prolonged periods.