Etiology of nosocomial diarrhea attributable to causes other than Clostridium difficile

Background. Clostridium difficile is known to cause 24.2% of nosocomial diarrheal cases. However, the remaining organisms are not studied in depth. This study investigated the relative prevalence of 5 other enteric pathogens. ^ Methods. This was a retrospective prevalence study of hospitalized patients who had negative stool tests for C. difficile from November 2014 through May 2015. Each sample was tested for Clostridium perfringens (C. perfringens), Staphylococcus aureus (S. aureus), Candida albicans (C. albicans), enteroaggregative Escherichia coli (EAEC), and Klebsiella oxytoca (K. oxytoca). Medical records were reviewed for antibiotic use prior to diarrheal episode as well as additional clinical characteristic. Descriptive statistics, Pearson’s χ 2 tests, Fischer’s exact test, and the Student’s t-test were used to analyze group and individual pathogen data. ^ Results. A total of 295 patients with nosocomial diarrhea met the inclusion criteria. Within this cohort, the prevalences of S. aureus, K. oxytoca, C. albicans, C. perfringens, and EAEC were 23.1%, 9.2%, 6.10%, 5.1%, and .7% respectively. 6.1% of patients had more than one pathogen, and 40% of patients had one or more pathogens overall. Length of stay between admission and ND onset was the most significantly correlated exposure in patients with ≥1 pathogens. ^ Conclusion. This study indicates that additional agents are present in cases of nosocomial diarrhea, warranting a need for further research and routine testing. Intestinal carriage of pathogens, not currently identified through stool samples, must also be considered.