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Enzyme Inhibitor Antibiotics and Antibiotic-Associated Diarrhea in Critically Ill Patients

Yanshu Zhang, Jingjing Sun, Jing Zhang, Yu Liu, Litao Guo

Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China (mainland)

Med Sci Monit 2018; 24:8781-8788

DOI: 10.12659/MSM.913739

Available online:

Published: 2018-12-04

BACKGROUND: This study aimed to analyze the factors associated with the development of antibiotic-associated diarrhea (AAD) in critically ill patients receiving enzyme inhibitor antibiotics.
MATERIAL AND METHODS: A retrospective study of patients with and without AAD admitted to the intensive care unit (ICU) of the First Teaching Hospital of Xi’an Jiaotong University from February 1, 2014, to January 31, 2016, was undertaken. Relevant clinical data underwent univariate or multivariate regression analysis.
RESULTS: Of 184 patients who received enzyme inhibitor antibiotic therapy, 70 patients (38.04%) developed AAD, with a mean duration of onset of 6.97±3.64 days. AAD was associated with the use of enzyme inhibitor antibiotic therapy alone (OR, 1.142; 95% CI, 1.038–1.256; P=0.007), and in combination with antifungal agents (OR, 2.449; 95% CI, 1.116–5.372; P=0.025), quinolones (OR, 5.219; 95% CI, 1.746–15.601; P=0.003), and oxazolidinones (OR 2.895; 95% CI, 1.183–7.083; P=0.020). The mean duration of ICU stay was significantly increased in patients with AAD (19.00±11.49 days vs. 9.60±6.76 days) (P<0.001). Mean duration of antibiotic therapy (14.09±8.82 days vs. 8.10±4.91 days) (P<0.001) and duration of enzyme inhibitor antibiotic therapy (9.26±5.06 days vs. 6.61±3.24 days) (P<0.001) were significantly increased in patients with AAD.
CONCLUSIONS: Duration of use of enzyme inhibitor antibiotic therapy and the combined use of antifungals, quinolones, and oxazolidinones increased the incidence and duration of AAD and increased the length of stay in ICU.

Keywords: Antifungal Agents, Clostridium difficile, diarrhea, Intensive Care Units