Antibiotic-Associated Diarrhea in ICU: JGH | March 2026
Introduction
Antibiotic-associated diarrhea (AAD) is a frequent and clinically significant complication of antimicrobial therapy, particularly in critically ill patients. The pathogenesis primarily involves disruption of the gut microbiota, leading to impaired intestinal barrier function and altered metabolism. In the intensive care unit (ICU), this risk is amplified due to severe illness, frequent use of broad-spectrum antibiotics, immunosuppression, and prolonged hospital stays. A substantial proportion of cases are related to Clostridioides difficile infection, which carries higher morbidity and mortality. However, data specific to ICU populations regarding incidence and risk stratification remain limited.
Problem Statement
The burden and predictors of antibiotic-associated diarrhea in critically ill patients are not well defined, limiting early identification and prevention strategies in ICU settings.
Summary
This meta-analysis highlights that AAD is highly prevalent in critically ill patients, affecting nearly 29%, while CDI-associated diarrhea occurs in approximately 12%. These figures confirm that diarrhea is not a minor complication but a major clinical issue in ICU practice.
Several important risk factors were identified. Patient-related factors such as older age, male sex, diabetes, and hypertension increase susceptibility. Treatment-related factors—including use of high-risk antibiotics (cephalosporins, carbapenems, glycopeptides), combination antibiotic therapy, antifungals, and prolonged antibiotic duration—significantly elevate risk. Critical illness severity, reflected by higher APACHE II scores and longer ICU stays, further compounds this risk. Interventions like mechanical ventilation, enteral nutrition, and parenteral nutrition also contribute, particularly for CDI.
Interestingly, the study also underscores the complexity of preventive strategies, with conflicting signals regarding commonly used interventions such as probiotics and proton pump inhibitors.
Clinically, this study emphasizes the need for risk-based antibiotic stewardship, early identification of high-risk patients, and tailored preventive strategies in ICU settings to reduce morbidity, mortality, and healthcare burden
