Nosocomial Diarrhea

Nosocomial Diarrhea:

• Definition: Loosening stool more than 3 times in at least 1 day, occurring after admission ≥ 72 hours.

Management Strategies:

1. For Faecal Impaction:

• Common in the elderly, patients with neurological diseases, or those immobilized.
• Rectal Impaction (Most common):
• Diagnosis: Perform PR (Per Rectal Examination).
• Treatment: Rectal enema (water/mineral oil) or digital removal if no response.
• High Impaction:
• Diagnosis: Abdominal plain film.
• Treatment: Water-soluble contrast enema via sigmoidoscope or PEG (Polyethylene Glycol) 2 L orally.

1. Drug-Related Diarrhoea:

• Common culprits include sorbitol, mycophenolate, colchicine, ARV (protease inhibitor), metformin, 5-FU, Azathioprine.
• Some drugs cause enterocolitis (fever, nausea/vomiting, mucous bloody stool), notably Mycophenolate, Azathioprine, and 5-FU.

1. Enteral Feeding Related Diarrhoea:

• Prevention strategies include using a lactose-free diet or fiber-containing formula, infusing continuously instead of bolus infusion. Concentration and site of feeding are not significant factors.

1. Antibiotics Associated or C.difficile Associated Diarrhoea:

• Causes include directly increasing motility (Erythromycin and Clavulanate) or decreasing non-pathogenic flora, leading to decreased conjugated bile, increased pathogens, and decreased short-chain fatty acids.
• Treatment:
• If no C.diff/WBC in stool: Stop/change ABT, administer bile salt resin (Cholestyramine).
• If C.diff/WBC in stool: Treat C.diff (Metronidazole or Vancomycin).
• If not responding: Consult GI for endoscopy and biopsy.

1. Intraabdominal Inflammation/Infection:

• Conditions include diverticulitis, UTI, bowel ischemia.

Note: The management of nosocomial diarrhea involves differentiating the cause and tailoring the treatment accordingly, from adjusting medications and dietary formulas to treating specific infections like C.difficile with targeted antibiotics.