NOSOCOMIAL DIARRHEA

Nosocomial diarrheas are an important problem in hospitals, and in cri tical care units in particular. Hospital-acquired diarrhea may be on a n infectious or noninfectious basis. Common noninfectious causes of no socomial diarrhea include medication-induced changes in the fecal nora or changes secondary to enteral hyperalimenation. Infectious causes o f nosocomial diarrhea are due to enteric pathogens in outbreak situati ons and virtually all of the causes are due to Clostridium Difficile. C. difficile is a resident of the human colon and does not cause disea se if its toxins are not elaborated. Chemotherapeutic agents, and more commonly, antibiotics, induce the elaboration of toxin A and B from C . difficile in the distal gastrointestinal tract. The spectrum of dise ase of C. difficile in hospitalized patients includes asymptomatic car riage to mild watery diarrhea, fulminant and severe diarrhea, and pseu domembranous enterocolitis. The treatment of C., difficile diarrhea is usually with oral metronidazole or vancomycin, and C. difficile colit is is treated with intravenous metronidazole. Infection control measur es are necessary to prevent the spread of this sporforming organism wi thin the institution since it is capable of surviving in the hospital environment for prolonged periods.