FACTORS ASSOCIATED WITH THE INCIDENCE OF NOSOCOMIAL DIARRHEA IN CRITICAL PATIENTS

Abstract

Introduction: The etiology of diarrhea is multifactorial, and its incidence is influenced by factors that contribute to worse clinical outcomes. Diarrhea is one of the most common complications during hospitalization in intensive care units (ICU) and is associated with prolonged hospitalization, increased healthcare costs, and higher mortality rates. Objective: To assess factors associated with the incidence of nosocomial diarrhea in critically ill patients. Methodology: This is a longitudinal, prospective study conducted with critically ill patients from March to September 2024, followed for up to ten days. Adults with a length of stay greater than 72 hours and receiving exclusive enteral nutrition were included. Exclusion criteria were patients with intestinal neoplasia, diarrhea upon admission, fecal impaction, diagnosis of inflammatory bowel disease, other comorbidities compromising intestinal integrity, use of chemotherapy, laxatives, or those readmitted to the ICU. Results: Of the 79 critically ill patients evaluated, 26.6% developed diarrhea, which was associated with longer hospitalization (6 days; p= 0.010), lower hemoglobin levels (9.3 g/dL; p= 0.042), and higher serum magnesium levels (2.3 mg/dL; p= 0.026). Among the factors triggering diarrhea, the full provision of calories and proteins increased the risk threefold (p<0.001). Conclusion: The full provision of calories and proteins was significantly associated with nosocomial diarrhea and contributed to a threefold increase in the likelihood of this outcome in the ICU. The length of stay also increased the chances of developing diarrhea. No association was observed between the administration of antibiotics and the occurrence of diarrhea.