Incidence of and risk factors for hospital-acquired diarrhea in three tertiary care public hospitals in Bangladesh

Abstract

During April 2007-April 2010, surveillance physicians in adult and pediatric medicine wards of three tertiary public hospitals in Bangladesh identified patients who developed hospital-acquired diarrhea. We calculated incidence of hospital-acquired diarrhea. To identify risk factors, we compared these patients to randomly selected patients from the same wards who were admitted > 72 hours without having diarrhea. The incidence of hospital-acquired diarrhea was 4.8 cases per 1,000 patient-days. Children < 1 year of age were more likely to develop hospital-acquired diarrhea than older children. The risk of developing hospital-acquired diarrhea increased for each additional day of hospitalization beyond 72 hours, whereas exposure to antibiotics within 72 hours of admission decreased the risk. There were three deaths among case-patients; all were infants. Patients, particularly young children, are at risk for hospital-acquired diarrhea and associated deaths in Bangladeshi hospitals. Further research to identify the responsible organisms and transmission routes could inform prevention strategies.

Figure 1.

(A) Crude incidence of hospital-acquired diarrhea per 1,000 patient-days at risk among hospitalized pediatric patients in Bangladesh, by month and hospital, 2007–2010. (B) Crude incidence of hospital-acquired diarrhea per 1,000 patient-days at risk among hospitalized patients in male medicine wards (we did not plot incidence data by month in adult female medicine wards because cases occurred infrequently) in Bangladesh, by month and hospital, 2007–2010.