Risk Factors for Antibiotic-Associated Diarrhea in Critically Ill Patients

BACKGROUND: We analyzed the factors related to AAD to inform the rational use of antibiotics in critically ill patients and to reduce the incidence of AAD by providing a reference for antibiotic use in the clinical setting. MATERIAL/METHODS: This study was a retrospective analysis of the clinical data of patients who were hospitalized in the ICU of the First Teaching Hospital of Xi’an Jiaotong University from January 1, 2015 to December 31, 2016. Patients with AAD were assigned to the case group, and all others were assigned to the control group. Basic data were collected for all the selected patients. All the relevant data were analyzed with univariate or multivariate regression analyses, and P<0.05 was considered statistical significance. RESULTS: A total of 293 patients were enrolled. Statistical analyses showed that gender (OR 1.915; 95% [CI] 1.061–3.455; P=0.031), parenteral nutrition (OR 1.877; 95% [CI] 1.043–3.377; P=0.036), preventive use of probiotics (OR 0.497; 95% [CI] 0.285–0.866; P=0.014), APACHE II score upon admission to the ICU (OR 0.961; 95% [CI] 0.927–0.998; P=0.037) and use of enzyme-inhibitor antibiotics (OR 1.899; 95% [CI] 1.044–3.420; P=0.016) were associated with AAD. Further subgroup analysis by gender showed that parenteral nutrition (OR 2.144; 95% [CI] 1.064–4.322; P=0.033), preventive use of probiotics (OR 0.367; 95% [CI] 0.186–0.722; P=0.004), and APACHE II score upon admission to the ICU (OR 1.055; 95% [CI] 1.011–1.101; P=0.014) were associated with AAD in critically ill male patients. Age (OR 0.975; 95% [CI] 0.951–0.999; P=0.041) and use of carbapenem antibiotics (OR 4.826; 95% [CI] 1.011–23.030; P=0.048) were associated with AAD in critically ill female patients. CONCLUSIONS: Parenteral nutrition, prophylactic use of probiotics, use of enzyme-inhibitor antibiotics, and use of combinations of antibiotics were associated with AAD in critically ill patients. The prophylactic use of probiotics may be a protective factor in AAD.