25. Nosocomial diarrhea and formula feeds: Iraqi perspectives

Abstract

Nosocomial diarrhea is an overlooked medical condition that is in fact a significant cause of morbidity and mortality. Nosocomial diarrhea is the onset of loose stool 72 hours after admission to the hospital and may or may not be associated with such symptoms as nausea, vomiting, fever, or abdominal pain. The most predominant pathogens causing nosocomial diarrhea are Enteropathogenic Escherichia coli, Clostridium difficile and Rota viruses. It is transmitted by the fecal-oral route by either one of two ways: (1) through contaminated objects, fluids and/or food; or (2) via contaminated medical instruments and/or the contaminated hands of medical and paramedical staff or non-medical hospital visitors. It should be noted that not all nosocomial diarrhea cases are infectious, as many cases are caused by the alteration of the patient’s normal flora as a result of diet change, changes in bowel osmolarity, or due to the intake of antibiotics medication such as erythromycin, amoxicillin/clavulanic acid, ceftriaxone, etc. Infectious nosocomial diarrhea is more prevalent in developing than in developed countries that usually have more cases of non-infectious nosocomial diarrhea. The prevalence of nosocomial diarrhea among Iraqi children under the age of 5 years was around 32.4%. Moreover, among the group of children under the age of 2 who developed nosocomial diarrhea 74% were bottle fed, while among those who did not develop nosocomial diarrhea 52% were exclusively breastfed. The infectious type of nosocomial diarrhea was usually more common in bottle fed infants than breast fed infants; while the non-infectious type was more prevalent in both breast and formula fed infants. Furthermore, the mixed types of infections were noticed among the bottle or mixedfed infants who developed nosocomial diarrhea while it was not noticed in infants who were exclusively breast fed. The prevention of nosocomial diarrhea can be achieved through physical or biological measures. Many medical researchers and practitioners described the positive impact of breast feeding on lowering the rate of nosocomial diarrhea, as mothers’ milk provides infants with optimal nutrition and protection against infection and contamination.