Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy

Table 1 Patient characteristics

Variables	AAD	No AAD	P value
No. of patients	45	164
Age, yr	62.93 ± 22.43	51.70 ± 20.97	0.002
Male/female	26/19	91/73	0.784
Hypertension, n (%)	18 (40.00)	47 (28.66)	0.145
Diabetes, n (%)	12 (26.67)	23 (14.02)	0.044
Parenteral nutrition, n (%)	27 (60.00)	82 (50.00)	0.249
proton pump inhibitors, n (%)	38 (84.44)	145 (88.41)	0.475
Duration of proton pump inhibitors, h	10.05 ± 9.67	6.88 ± 5.28	0.007
Gastrointestinal surgery, n (%)	3 (6.67)	8 (4.88)	0.921
Fasting time exceeding 72 h, n (%)	18 (40.00)	81 (49.39)	0.264
Use of glucocorticoid, n (%)	14 (31.11)	65 (39.63)	0.296
Albumin levels, g/L	31.87 ± 5.52	32.28 ± 8.14	0.746
White blood cell count into the ICU, × 109/L	13.66 ± 8.59	13.11 ± 6.98	0.658
APACHE II score at admission into the ICU, points	18.45 ± 7.33	16.63 ± 8.05	0.177
Duration of antibiotic, d	10.24 ± 5.94	6.19 ± 3.11	< 0.001
ICU stay time, d	15.89 ± 10.69	8.49 ± 6.31	< 0.001
ICU mortality, n (%)	3 (6.67)	16 (9.76)	0.729

AAD: Antibiotic-associated diarrhea; ICU: Intensive care unit.

Table 2 Infection sites of patients

Infection sites	AAD (%)	No AAD (%)	P value
No. of patients	45	164
Lung infection	34 (75.56)	104 (63.41)	0.128
Abdominal infection	3 (6.67)	11 (6.71)	0.992
Hematogenously disseminated infection	1 (2.22)	8 (4.88)	0.717
Central nervous system infection	1 (2.22)	6 (3.66)	0.995
Urinary tract infection	2 (4.44)	16 (9.76)	0.409
Other	4 (8.89)	19 (11.58)	0.808

AAD: Antibiotic-associated diarrhea.

Table 3 Antibiotic monotherapy and antibiotic-associated diarrhea, n (%)

Variables	AAD	No AAD	P value
No. of patients	45	164
Beta-lactam plus enzyme inhibitors	33 (73.34)	92 (56.10)	0.037
Carbapenems	7 (15.56)	32 (19.51)	0.564
Cephalosporins	1 (2.22)	22 (13.41)	0.063
Quinolones	2 (4.44)	10 (6.10)	0.952
Antifungals	2 (4.44)	2 (1.22)	0.433
Glycopeptides	0 (0.00)	2 (1.22)	-
Oxazolidinones	0 (0.00)	4 (2.44)	-

The Beta-lactam plus enzyme inhibitor antibiotics were piperacillin-tazobactam and cefoperazone-sulbactam. AAD: Antibiotic-associated diarrhea.

Table 4 Factors related to antibiotic-associated diarrhea in critically ill patients receiving antibiotic monotherapy

Related factors	Univariate logistic regression analysis		Multivariate logistic regression analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Age	1.026 (1.009-1.044)	0.003	1.022 (1.001-1.044)	0.040
Gender	1.098 (0.563-2.139)	0.784
Proton pump inhibitors	1.406 (0.551-3.589)	0.476
Duration of proton pump inhibitors	1.064 (1.013-1.117)	0.013	1.129 (1.020-1.249)	0.019
Parenteral nutrition	1.482 (0.758-2.898)	0.251
Albumin levels	1.007 (0.964-1.052)	0.745
Hypertension	1.660 (0.836-3.295)	0.148
Diabetes	2.229 (1.007-4.933)	0.048	1.072 (0.345-3.333)	0.904
ICU stay time	1.111 (1.062-1.162)	< 0.001	1.133 (1.041-1.234)	0.004
APACHE II score at admission into the ICU	1.029 (0.987-1.073)	0.179
Duration of antibiotic	1.247 (1.139-1.367)	< 0.001	1.163 (1.024-1.320)	0.020
Gastrointestinal surgery	1.393 (0.354-5.481)	0.635
Fasting time exceeding 72 h	1.022 (0.887-1.179)	0.265
Glucocorticoid	1.454 (0.719-2.941)	0.298
White blood cell count into the ICU	1.010 (0.967-1.055)	0.656
Infection sites	1.097 (0.923-1.303)	0.294
Cephalosporins	6.817 (0.893-52.026)	0.064
Carbapenems	1.316 (0.538-3.217)	0.547
Beta-lactam plus enzyme inhibitors	2.152 (1.038-4.462)	0.039	1.480 (0.594-3.688)	0.400
Quinolones	1.396 (0.295-6.613)	0.674
Antifungals	3.767 (0.516-27.522)	0.191

Beta-lactam plus enzyme inhibitor antibiotics were piperacillin-tazobactam and cefoperazone-sulbactam. ICU: Intensive care unit; OR: Odds ratio; CI: Confidence interval.