DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med. 2014 Apr 17;370(16):1532-40. doi: 10.1056/NEJMra1301069. Review. PubMed PMID: 24738670.
Definition, Etiology, PathogenesisTop
Nosocomial diarrhea refers to diarrhea that develops during a hospital stay or up to 3 days after discharge. Nosocomial diarrhea is typically noninfectious and caused by adverse effects of drugs, enteral feeding with hyperosmotic liquid formulas, or surgery of the gastrointestinal tract. The infectious etiology of nosocomial diarrhea in hospitalized adults is predominantly related to Clostridium difficile (responsible for 90% of cases of diarrhea developing within 3 days of hospital admission; see Clostridium difficile Infection).
Clinical Features and DiagnosisTop
Start by excluding or confirming infectious etiology of diarrhea. The infectious etiology should be suspected if the diarrhea occurs in a patient treated with antibiotics (even up to 2 months after the treatment) and is associated with fever, vomiting, and abdominal cramping, or manifests as an epidemic of acute gastroenteritis limited to a particular hospital ward (norovirus infection).
Do not perform routine diagnostics of bacterial infections other than those caused by C difficile (results are usually negative), except for hospital epidemics of inflammatory diarrhea or dysentery and patients in whom C difficile infection was excluded.
Treatment and Prevention Top
Treatment and prevention of C difficile infection: see Clostridium difficile Infection.