Diarrhea in hospitalized patients

Clostridium difficle has been associated with diarrhea in hospitalized patients receiving antibiotic therapy and may be nosocomially acquired. Rehabilitation hospital inpatients may require frequent antibiotic intervention and are thus at risk, although few reports of epidemics at such centers have been published. This study describes the impact of C. difficle-related disease among rehabilitation hospital inpatients. A retrospective review was conducted of all inpatients evaluated for diarrhea in two freestanding rehabilitation hospitals over a 13-month period. Clostridium difficle was determined to be the etiologic agent of diarrhea in 36% of the 33 patients, and no other etiologies were identified. Four patients were transferred to acute care because of the severity of symptoms. A total of 120 altered or canceled therapy sessions were observed to occur during the rehabilitative hospital course among studied patients, of which 90% (108) occurred during periods when patients were documented to have been symptomatic for diarrhea. Diarrhea and C. difficile-related disease thus appear to exert an important and adverse impact on the hospital course of these patients, both in terms of medical complications and therapy attendance. Physicians should therefore possess a heightened index of suspicion for C. difficile infection when evaluating patients with diarrhea in this setting. Diagnostic evaluation of rehabilitation hospital inpatients with diarrhea should include C. difficile toxin assay. If the results of the toxin assay are positive, appropriate therapy, including initiation of oral vancomycin or metronidazole and avoidance of antimotility drugs, should be instituted promptly to minimize risk of potential sequelae.