Hospital acquired diarrhea in a burn center of Tehran

Incidence of hospital-acquired diarrhea has increased rapidly and burn patients are at high risk of getting it. Infection with C. difficile is the most common cause of antibiotic associated diarrhea. The aim of this study was to determine the baseline characteristics and clinical presentation of hospital-acquired diarrhea and compare C. difficile and non-C. difficile diarrhea in burn patients treated at a burn center.

During a 1-year study all patients with hospital-acquired diarrhea at Motahari Burn Hospital, Tehran, Iran enrolled in this study. We compared patients with a stool sample positive for C. difficile toxin or tracing the antigen in patients who were negative for detection of toxin in their stool sample specimens.

Diarrhea developed in 37 patients out of 3200 admitted patients with a mean burn size of 34.8 ±20.1%. Among them, 8 patients had a positive result for C. difficile. The mean time between antibiotic therapy and occurrence of diarrhea was 9.5 ± 6.2 days. Nine (23.7%) patients died in the 7.8± 4.2 days, mostly due to co-morbidities. The mean duration of diarrhea was 3.6 ± 2 days. Twenty two (57.9%) patients were treated with oral metronidazol and eleven (28.9%) patients were treated with combination of metronidazole and vancomycin, higher rate of combination therapy was seen in Clostridium difficile CDI.

Overall, the prevalence of hospital-acquired diarrhea was 120/10,000 and 21% of them caused by infection with C. difficile. Presence of peripheral leukocytosis and colitis were the alarm sign for diagnosis of C. difficile infection.