Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

Autor:	Mawer D; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. Electronic address: damian.mawer@york.nhs.uk., Byrne F; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Drake S; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Brown C; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Prescott A; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK., Warne B; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK., Bousfield R; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK., Skittrall JP; Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK., Ramsay I; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK., Somasunderam D; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK., Bevan M; Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK., Coslett J; Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK., Rao J; Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK., Stanley P; Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK., Kennedy A; Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK., Dobson R; Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK., Long S; Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK., Obisanya T; Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK., Esmailji T; Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK., Petridou C; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., Saeed K; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., Brechany K; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., Davis-Blue K; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., O'Horan H; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., Wake B; Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK., Martin J; Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK., Featherstone J; Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK., Hall C; Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK., Allen J; Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK., Johnson G; Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK., Hornigold C; Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK., Amir N; Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK., Henderson K; Inverclyde Royal Hospital, Greenock, PA16 0XN, UK., McClements C; Inverclyde Royal Hospital, Greenock, PA16 0XN, UK., Liew I; Inverclyde Royal Hospital, Greenock, PA16 0XN, UK., Deshpande A; Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK., Vink E; Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK., Trigg D; Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK., Guilfoyle J; Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK., Scarborough M; Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK., Scarborough C; Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK., Wong THN; Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK., Walker T; Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK., Fawcett N; Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK., Morris G; Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK., Tomlin K; Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK., Grix C; Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK., O'Cofaigh E; Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK., McCaffrey D; Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK., Cooper M; Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Corbett K; Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., French K; Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Harper S; Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Hayward C; Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Reid M; Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Whatley V; Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Winfield J; Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK., Hoque S; Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK., Kelly L; Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK., King I; Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., Bradley A; Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., McCullagh B; Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., Hibberd C; Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., Merron M; Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., McCabe C; Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK., Horridge S; Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK., Taylor J; Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK., Koo S; Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK., Elsanousi F; Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK., Saunders R; Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK., Lim F; Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK., Bond A; Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK., Stone S; Royal Free Campus, University College Medical School, London, NW3 2QG, UK., Milligan ID; Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK., Mack DJF; Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK., Nagar A; Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK., West RM; Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK., Wilcox MH; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK., Kirby A; Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK., Sandoe JAT; Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK.
Jazyk:	angličtina
Zdroj:	The Journal of hospital infection [J Hosp Infect] 2019 Oct; Vol. 103 (2), pp. 200-209. Date of Electronic Publication: 2019 May 08.
DOI:	10.1016/j.jhin.2019.05.001
Abstrakt:	Background: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. Aim: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. Methods: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. Findings: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. Conclusion: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated. (Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Full Text from ScienceDirect