D Mawer1, F Byrne2, S Drake2, C Brown2, A Prescott2, B Warne3, R Bousfield3, J P Skittrall4, I Ramsay3, D Somasunderam3, M Bevan5, J Coslett5, J Rao6, P Stanley7, A Kennedy7, R Dobson7, S Long8, T Obisanya8, T Esmailji8, C Petridou9, K Saeed9, K Brechany9, K Davis-Blue9, H O'Horan9, B Wake9, J Martin10, J Featherstone10, C Hall11, J Allen11, G Johnson11, C Hornigold11, N Amir12, K Henderson13, C McClements13, I Liew13, A Deshpande14, E Vink15, D Trigg16, J Guilfoyle16, M Scarborough17, C Scarborough18, T H N Wong17, T Walker17, N Fawcett19, G Morris20, K Tomlin21, C Grix21, E O'Cofaigh22, D McCaffrey23, M Cooper24, K Corbett25, K French24, S Harper25, C Hayward25, M Reid25, V Whatley26, J Winfield25, S Hoque27, L Kelly28, I King29, A Bradley29, B McCullagh30, C Hibberd30, M Merron29, C McCabe29, S Horridge31, J Taylor32, S Koo33, F Elsanousi33, R Saunders33, F Lim33, A Bond34, S Stone35, I D Milligan36, D J F Mack36, A Nagar37, R M West38, M H Wilcox39, A Kirby40, J A T Sandoe40. 1. Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. Electronic address: damian.mawer@york.nhs.uk. 2. Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. 3. Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK. 4. Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK. 5. Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK. 6. Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK. 7. Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK. 8. Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK. 9. Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK. 10. Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK. 11. Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK. 12. Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK. 13. Inverclyde Royal Hospital, Greenock, PA16 0XN, UK. 14. Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK. 15. Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. 16. Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK. 17. Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK. 18. Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK. 19. Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK. 20. Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK. 21. Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK. 22. Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK. 23. Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK. 24. Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK. 25. Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK. 26. Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK. 27. Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK. 28. Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK. 29. Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK. 30. Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK. 31. Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK. 32. Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK. 33. Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK. 34. Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK. 35. Royal Free Campus, University College Medical School, London, NW3 2QG, UK. 36. Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK. 37. Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK. 38. Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK. 39. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK. 40. Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK.
Abstract
BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.