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

D. Mawer*, F. Byrne, S. Drake, C. Brown, A. Prescott, B. Warne, R. Bousfield, J. P. Skittrall, I. Ramsay, D. Somasunderam, M. Bevan, J. Coslett, J. Rao, P. Stanley, A. Kennedy, R. Dobson, S. Long, T. Obisanya, T. Esmailji, C. PetridouK. Saeed, K. Brechany, K. Davis-Blue, H. O'Horan, B. Wake, J. Martin, J. Featherstone, C. Hall, J. Allen, G. Johnson, C. Hornigold, N. Amir, Katherine Henderson, C. McClements, I. Liew, A. Deshpande, E. Vink, D. Trigg, J. Guilfoyle, M. Scarborough, C. Scarborough, T. H.N. Wong, T. Walker, N. Fawcett, G. Morris, K. Tomlin, C. Grix, E. O'Cofaigh, D. McCaffrey, M. Cooper, K. Corbett, K. French, S. Harper, C. Hayward, M. Reid, V. Whatley, J. Winfield, S. Hoque, L. Kelly, I. King, A. Bradley, B. McCullagh, C. Hibberd, M. Merron, C. McCabe, S. Horridge, J. Taylor, S. Koo, F. Elsanousi, R. Saunders, F. Lim, A. Bond, S. Stone, I. D. Milligan, D. J.F. Mack, A. Nagar, R. M. West, M. H. Wilcox, A. Kirby, J. A.T. Sandoe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)200-209
Number of pages10
JournalJournal of Hospital Infection
Volume103
Issue number2
DOIs
Publication statusPublished - Oct 2019
Externally publishedYes

Bibliographical note

Funding Information:
Damian Mawer received a fellowship grant from the Healthcare Infection Society to undertake this work. Mark Wilcox reports grants and personal fees from Actelion , grants and personal fees from Cubist , grants and personal fees from Astellas , grants and personal fees from Merck , grants and personal fees from Sanofi-Pasteur , grants and personal fees from Summit , grants and personal fees from Seres , grants and personal fees from Biomerieux , grants from Da Volterra , personal fees from Valneva , personal fees and other from Alere , grants and personal fees from Qiagen , grants and personal fees from Pfizer , other from Astellas Pharma , non-financial support from Astellas Pharma, personal fees from Ferring , personal fees from Synthetic Biologics , during the conduct of the study; personal fees from Astra Zeneca , personal fees from Nabriva , personal fees from Pfizer , personal fees from Roche , personal fees from The Medicine Company , grants and personal fees from Abbott , personal fees from Basilea , grants and personal fees from European Tissue Symposium , personal fees from Bayer , personal fees from Allergan , personal fees from Menarini , personal fees from Motif Biosciences , grants and personal fees from Paratek , personal fees from AiCuris , personal fees from Antabio , personal fees from Spero , grants and personal fees from Tetraphase , grants and personal fees from Surface Skins , outside the submitted work. None of the other authors have any conflicts of interest to declare.

Funding Information:
Damian Mawer received a fellowship grant from the Healthcare Infection Society to undertake this work. Mark Wilcox reports grants and personal fees from Actelion, grants and personal fees from Cubist, grants and personal fees from Astellas, grants and personal fees from Merck, grants and personal fees from Sanofi-Pasteur, grants and personal fees from Summit, grants and personal fees from Seres, grants and personal fees from Biomerieux, grants from Da Volterra, personal fees from Valneva, personal fees and other from Alere, grants and personal fees from Qiagen, grants and personal fees from Pfizer, other from Astellas Pharma, non-financial support from Astellas Pharma, personal fees from Ferring, personal fees from Synthetic Biologics, during the conduct of the study; personal fees from Astra Zeneca, personal fees from Nabriva, personal fees from Pfizer, personal fees from Roche, personal fees from The Medicine Company, grants and personal fees from Abbott, personal fees from Basilea, grants and personal fees from European Tissue Symposium, personal fees from Bayer, personal fees from Allergan, personal fees from Menarini, personal fees from Motif Biosciences, grants and personal fees from Paratek, personal fees from AiCuris, personal fees from Antabio, personal fees from Spero, grants and personal fees from Tetraphase, grants and personal fees from Surface Skins, outside the submitted work. None of the other authors have any conflicts of interest to declare.Damian Mawer was funded by the Healthcare Infection Society during the work. Jordan Skittrall is funded by a National Institute for Health Research Academic Clinical Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would like to thank the following for their contribution to this study: Graziella Kontkowski (from UK C. difficile Support) provided insights into the importance of HOD from a patient perspective; in Leeds, Dermot Burke, Clare Donnellan and Claire Berry; in Papworth, Margaret Gillham, Helen Wickenden and Victoria Stoneman; in Belfast, Michelle Copeland; and in Hampshire Hospitals NHS Foundation Trust, Hazel Gray.

Funding Information:
Damian Mawer was funded by the Healthcare Infection Society during the work. Jordan Skittrall is funded by a National Institute for Health Research Academic Clinical Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Publisher Copyright:
© 2019 The Healthcare Infection Society

Keywords

  • Clostridium difficile
  • Diarrhoea
  • Hospital acquired
  • Hospital onset
  • Nosocomial

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