# Impact of enteral feeding strategies on nosocomial Clostridioides difficile infection-induced diarrhea

## TL;DR

This study explores how different enteral feeding methods affect the severity of Clostridioides difficile infection-induced diarrhea in hospitalized patients.

## Contribution

The study identifies continuous enteral feeding as a strategy associated with milder CDI-related diarrhea and better biochemical stability.

## Key findings

- Continuous enteral feeding was strongly associated with milder diarrhea compared to intermittent feeding.
- Continuous feeding stabilized sodium levels, while intermittent feeding correlated with elevated creatinine and reduced albumin/hemoglobin.
- Over 90% of patients received antibiotics and proton pump inhibitors, highlighting the need for medication stewardship.

## Abstract

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhea, associated with prolonged hospitalization, increased costs, and higher mortality. Diarrhea severity is influenced by host factors, biochemical markers, and nutritional support. Although enteral feeding is essential when oral intake is not feasible, the impact of feeding mode and system type on CDI-related diarrhea remains underexplored. This study examined associations between enteral feeding strategies and diarrhea severity, along with relevant biochemical markers and medication use, particularly antibiotics and proton pump inhibitors.

A retrospective cross-sectional investigation was conducted on adult CDI patients across tertiary hospitals in Saudi Arabia’s Eastern Province (Jan 2020–May 2025). Of 97 records, 78 met inclusion criteria. Demographic, nutritional, and biochemical data—including sodium, creatinine, albumin, and hemoglobin—were analyzed.

All cases ranged from mild to moderate diarrhea; males comprised 57.1%. Continuous feeding strongly associated with milder diarrhea compared to intermittent feeding (OR = 7.91; 95% CI: 2.688–23.253; p < 0.001). Feeding system type showed a non-significant trend, with open systems linked to more moderate cases. Continuous feeding stabilized sodium, while intermittent feeding correlated with elevated creatinine and reduced albumin/hemoglobin. Leukocytosis, hypoalbuminemia, and creatinine elevation emerged as prognostic markers. Over 90% of patients received antibiotics and PPIs concurrently, underscoring stewardship needs.

Continuous enteral feeding appears clinically advantageous in CDI, improving tolerance and biochemical stability. Findings highlight the importance of nutritional monitoring, electrolyte management, and rational prescribing. Region-specific evidence contributes to global CDI literature and supports future prospective studies to refine feeding strategies.