PURPOSE: Diarrhea represents a significant co-morbidity in the critically-ill patient. Although infectious diarrhea such as Clostridium difficile is well recognized as an etiology, the incidence of non-infectious diarrhea in the critically ill is not known. The aim of our study was to determine the significance of non-infectious diarrhea in the intensive care unit (ICU) and its impact on resource utilization.
METHODS: We conducted a prospective chart review of patients in the ICU over a 3 month time period. Patients who developed diarrhea, defined as 3 or more episodes of loose stool in 24 hours, and whose ICU stay was greater than 3 days were included. We excluded patients with diarrhea on admission to the ICU. Data collected included patient age, antibiotic treatment, type of feeding, use of H2-antagonists or proton pump inhibitors, and results of C. difficile testing.
RESULTS: 307 patients were admitted to the ICU from August 2009 to October 2009. The incidence of diarrhea was 6% (n=19). The majority of patients received antibiotics for non-gastrointestinal infections (89%), enteral tube feedings for nutrition (84%), and H2-antagonists for stress ulcer prophylaxis (74%). C. difficile tests were performed on 16 patients with diarrhea (84%). Seven patients were started on empiric treatment for C. difficile colitis however only 2 patients had confirmed C. difficile infection. Thirty-two C. difficile tests were performed at a cost of $4544.00. Based on the average wholesale price (AWP) for oral vancomycin and oral and intravenous metronidazole, the cost of empiric treatment for C. difficile was $710.58. The total cost of testing and empiric treatment was $5254.58.
CONCLUSION: The incidence of diarrhea in our ICU was 6% and the majority of cases were non-infectious. The cost of testing and empirically treating for C. difficile over a 3 month period was $5254.58.
CLINICAL IMPLICATIONS: Testing and empiric treatment for infectious causes of diarrhea increases the cost of care and should be reserved for patients in which there is a strong suspicion of infection.
DISCLOSURE: Alia Hasham, No Financial Disclosure Information; No Product/Research Disclosure Information