Etiology And Risk Factors For Hospital-Acquired Diarrhea In Children

Abstract

Background and Objectives: Hospital-acquired diarrhea (HAD) remains an underrecognized healthcare-associated infection in low- and middle-income countries, with limited regional data from Iraq. This study aimed to investigate the etiology, risk factors, and clinical characteristics of HAD among hospitalized adults in Erbil’s tertiary care hospitals.

Methods: A cross-sectional observational study was carried out for the duration of January to December 2024 in three major hospitals in Erbil, involving 300 children patients (≤18 years) who developed diarrhea ≥ 72 hours after hospital admission. Sociodemographic, clinical, and microbiological data were collected through standardized data collection forms, and stool samples were tested by using culture methods, RT-PCR and parasitological methods.

Results: Of the 300 participants (mean age =10.41 ± 5.06 years; 56.6% male), 66.7% had identifiable pathogens. Bacterial pathogens predominated (E. coli 9.7%, C. difficile 13.0%, Salmonella 5.0%, Shigella 4.3%; p = 0.043), followed by viral (rotavirus 10.0%, norovirus 7.3%, adenovirus 5.0%) and parasitic (Giardia 7.7%, Cryptosporidium 5.0%) infections. The majority occurred in medical wards (40.7%) with mean diarrhea frequency of 5.85 ± 2.82 episodes/day. Significant risk factors included antibiotic exposure (73.3%; p < 0.001), particularly meropenem (19.3%) and azithromycin (16.7%), and proton pump inhibitor use (57.0%; p = 0.006). The mean hospital stay was 12.33 ± 7.46 days.

Conclusion: HAD in hospitals in Erbil is primarily of bacterial origin, most notably Clostridium difficile, and is significantly associated with the use of antibiotics and proton pump inhibitors. Thus, measures to advance antimicrobial stewardship, infection control, and diagnostic surveillance are necessary to limit in-hospital transmission, and improve patient care.