Study of diarrhea in critically ill patients.

There has been an impression that diarrhea occurs commonly in seriously ill patients treated in ICUs. In view of the sparsity of published work on the problem, we embarked on a prospective study of all patients admitted to the ICU for more than 48 h over a 12-month period. Three factors were examined in detail: nasogastric feeding, cimetidine administration, and antibiotic treatment. Other factors also were considered, notably the nature of the underlying illness and the spread of a possible infective agent by cross-infection. There was a 41% incidence of diarrhea. A significant increase in the incidence of diarrhea occurred in patients on nasogastric feeding (p less than 0.01) and in those receiving cimetidine (p less than 0.05); there was no increased incidence in those receiving antibiotic therapy. The cytotoxin of Clostridium difficile was specifically looked for in all patients with diarrhea, but was not detected.