Frequency and risk factors for antibiotic-associated diarrhea among hospitalized children

Aim: Antibiotic-associated diarrhea (AAD) is defined as diarrhea that presents during or after discontinuation of antibiotics. It may present as early as within 1-2 hours after initiation of antibiotics but may also present after several weeks after discontinuation of antibiotics. The diagnosis of AAD made after exclusion of all other causes of diarrhea or documentation of diarrhea association with Clostridium difficile. Prevalence of AAD in children is changed according to diagnostic criteria and was reported between 5% and 30% in out patients. Deterioration of intestinal flora by antibiotic usage may cause several symptoms, especially diarrhea. The clinical presentation may vary from mild diarrhea to fulminant pseudomembranous colitis. This condition may cause prolonged hospitalization, and may effect the morbidity and mortality negatively. Data about the frequency of AAD among the hospitalized patient is lacking and the association about the antibiotics and diarrhea is still uncertain. Frequency of AAD will be calculated and risk factors for the diarrhea will be analyzed. Our data will be considered when initiating antibiotics among hospitalized children and preventive measurements among children with risk factors, will decrease the morbidity and mortality. Patients and methods: Between October 2018 and October 2019, patients between 1 month and 18 years old were included in the pediatric adolescent, infancy and infection wards of Karadeniz Technical University Faculty of Medicine, who took antibiotics at their admission and met the selection criteria. Stool material of the patients with diarrhea will be tested for adenovirus, rotavirus, norovirus, Salmonella spp., Shigella spp., Campylobacter spp., and Clostridium difficile toxin A and B, stool culture and Clostridium difficile culture. Patients with Clostridium difficile associated diarrhea or without any proven etiology will be accepted as AAD. Results: During the study, 1042 patients were followed and 451 patients were given antibiotics. 358 of these patients met the study criteria. 179 (50%) of the 358 patients were male, the median age was 36 months and diarrhea developed in 32 of them in the follow-up. Adenovirus in 1 case, rotavirus in 6 cases and norovirus in 3 cases were detected. One patient with positive C. difficile Toxin B and 21 without diarrhea, a total of 22 (6.14%) cases were accepted as ADD. Patients were male and under 3 years of age (77.3% vs 48.2%, p=0.008), the use of carbapenem group antibiotics (13.6% vs 3.9%, p=0.032), the addition of ibuprofen (10.8% vs 89.2%, p=0.014) and the initiation of antibiotics 24 hours after hospitalization (33.7% vs 4.7%, p<0.001), we found that it increased the risk of ADD. Finally, we compared these risk factors with logistic regression analysis and found that male gender, being under 3 years of age, starting antibiotics 24 hours after hospitalization, and use of ibuprofen were associated with ADD. Conclusion: Antibiotic-associated diarrhea is a side effect due to antibiotic use and negative consequences can be seen with the destruction of the gastrointestinal flora. Our results about ADD are similar to the results of studies conducted in other countries. Antibiotherapy started 24 hours after the hospital, boys under the age of 3, who have been added ibuprofen to their treatment should be observed more carefully in terms of ADD. Key words: Antibiotic - associated diarrhea, frequency, patient