สาเหตุของภาวะอุจจาระร่วงของผู้ป่วยรับไว้รักษาตัวในกองอายุรกรรม โรงพยาบาลพระมงกุฎเกล้า

Abstract

To find ou the etiology of nosocomial diarrhea in patients admitted in Department of Medicine Phramongkutklao Hospital Background:         Nosocomiald iarrhea is one of the common problemse specially in i ntensivecare unit. It is also estimated that 1/3 of critical care patients have nosocomial diarrhea. However the suitable planof management is still not established for example some patiens with nosocomial diarrhea were treated withmetronidazole without clear evidence oreover  the prevalence of nosocomial diarrhea in Department of Medicine Phramongutklao Hospital still has not studied yet. Method: his is the prospective study in 45 patients whoadmitted in Department of Medicine Phramongkutklao Hospital from July 2005 to January 2007. Patients who admitted more than 3 days and have bowel movement more than 3 times a day were included. All patients were investigated to find out etiology of diarrhea for example stool examination stool culture and stool difficile toxin. Patients who were clinically stable with no systemic inflammatory response syndrome (SIRS) no peritoneal irritationsign and stool examination showed no evidence of inflammation then enteral feeding were stopped less than 48hours for evaluation of response. Tube feeding associated diarrhea was diagnosed if clinical diarrhea improved afterstop enteral feeding. In case of unknown etiology the Gastroenterolgists were consulted for sigmoidoscope to ruleout pseudomembranous colitis. Result: After investigation 56% of patients have known causes of diarrhea and 44%of patients still have unknown causes. Tube feeding associated diarrhea was the most common which were  found24% of total cases. The second most common cause was C.difficile associated diarrhea which were found  20%. Infective diarrhea was the cause of diarrhea only 6.6% and Salmonella group C was the organism which   ausediarrhea. A few cases caused by drug induced diarrhea. Conclusion: From this result the most common  causeof nosocomial diarrhea was tube feeding associated diarrhea. However after routine investigation 44% of patientsstill have unknown causes.