Infectious Nosocomial Diarrhea in the Surgical Wards: Role of Parasites and Microbes Imply Stool Analysis

Abstract

This is the first study to document the etiology of non-outbreak infectious nosocomial diarrhea in surgical wards, in Al-Madinah Al-Munawarh hospitals, Saudi Arabia. Fecal samples were collected from all hospitalized patients in surgical wards having diarrheic stool 72 hours after hospitalization with no co-morbid diarrhea or intestinal disturbances on hospitalization during the period from September, 2007 to March, 2008. They were analyzed by copro-scopical, fecal culture, and copro-ELISA methods. Enteropathogens were revealed in 51.9% of cases; about third of them had combined infections. C.difficile toxin A&B with or without antibiotic use was the leading cause (21.7%), followed by E.coli O157 (17.8%). While parasites were not listed as common causes of infectious nosocomial diarrhea, protozoa were detected in 19.8% of cases; Cryptosporidium parvum (6.6%), B.hominis (6.6%), G.lamblia (3.5%) and E.histolytica (3.1%). Heavy yeast colonization was isolated from 3.5% of cases and Rotavirus coproantigens in 1.2%. Stool specimen analysis 72 h after admission would be of value for parasites and microbes in hospitalized patients. Patients who had prolonged duration of hospitalization, complicated surgical procedures, pre-existing co-morbidity, taking medications especially antibiotics, or at extremes of ages were high risk groups. The numbers of fecal specimens examined, fecal concentration, and fecal ELISA, increase the recovery rate of stool examination. In addition, the morbidity was greater than reported, which implicate the request for stool examination and the role of parasites and microbes as an etiology of nosocomial diarrhea in surgical wards.