OBJECTIVES: Although the burden of diarrhea is much lower in developed countries, it is a significant public health problem, especially in ICUs in the hospitals of developing countries like India. This study assesses the direct medical costs and financial burden associated with diarrhea in ICU in a single hospital in South-India.

METHODS: In this cross-sectional observational study, the patients admitted in the ICU during the study period (October 2019 to March 2020) were observed for diarrhea. Patients with age ≥ 18 years, who stayed at least 48 hours in the medical-ICU, on prophylactic dose-laxative therapy for preventing complication were included. Patients on laxative therapy (higher dose) and enema, with diarrheal complaints on admission or during ward stay were excluded.

RESULTS: Among 621 ICU admissions, 82 patients were presented with nosocomial-diarrhea and incidence was 13.20. The mean age was 64 years (IQR 54-76) and mean ICU length of stay was 7 days (IQR 6-8). Total mean direct-costs attributed to diarrhea in ICU was 192 USD (IQR 51-315). The mean medication cost for managing diarrhea was 18 USD (IQR 5-18) as well as interventional mean cost was 110 USD. Mean laboratory costs due to diarrhea were found to be USD 74 (IQR 23-116) with mean diagnostic cost of USD 37 (IQR 11-58). Mean cost for stool culture was 4 USD, the average cost of toxin and Glutamate Dehydrogenase test of Clostridium difficile was USD 17. Additional mean costs of ICU stay and hospital-stay associated with diarrhea were 82 USD and 13 USD respectively.

CONCLUSIONS: This study brought to light, the extra burden caused by diarrhea in terms of cost for its diagnosis, management and also extended length of stay from a patient perspective. Diarrhea in critically ill patients increases the workload of doctors, nurses and also escalate manpower-related costs in the ICU.