The Incidence and Risk Factors of Antibiotic‐Associated Diarrhea in Critically Ill Patients: A Systematic Review and Meta‐Analysis

BACKGROUND/AIMS: This meta-analysis aims to quantitatively assess the incidence and risk factors of both antibiotic-associated diarrhea (AAD) and Clostridioides difficile-associated diarrhea (CDAD) in critically ill patients. METHODS: We searched Cochrane Library, Web of Science, Embase, PubMed, CNKI, and Wanfang until February 2025. Studies were screened, extracted, and assessed using the Newcastle-Ottawa Scale and GRADE. Analyses used RevMan 5.4 and Stata 15. RESULTS: This meta-analysis revealed an overall incidence of AAD of 29% (95% CI = 24%-35%) in critically ill patients. The following 16 independent risk factors were identified: age (MD = 4.81, 95% CI = 2.85-6.78), male (OR = 1.23, 95% CI = 1.04-1.45),hypertension (OR = 1.86, 95% CI = 1.51-2.29), diabetes (OR = 1.42, 95% CI = 1.11-1.82), cephalosporin (OR = 1.67, 95% CI = 1.31-2.12), glycopeptide antibiotic (OR = 1.48, 95% CI = 1.10-1.98), antifungal agent (OR = 2.55, 95% CI = 1.90-3.41), β-lactam plus enzyme inhibitor (OR = 2.38, 95% CI = 1.86-3.06), proton pump inhibitor (OR = 0.56, 95% CI = 0.37-0.85), probiotic (OR = 1.69, 95% CI = 1.20-2.36), combined antibiotic use (OR = 2.44, 95% CI = 1.96-3.04), gastrointestinal surgery (OR = 2.00, 95% CI = 1.20-3.34), parenteral nutrition (OR = 1.60, 95% CI = 1.18-2.16), duration of antibiotic use (MD = 4.15, 95% CI = 2.93-5.37), APACHE II score (MD = 1.10, 95% CI = 0.55-1.65), and length of ICU stay (MD = 7.02, 95% CI = 4.39-9.66). Additionally, the incidence of CDAD was 12% (95% CI = 7%-17%), with risk factors including enteral nutrition (OR = 2.11, 95% CI = 1.37-3.24), mechanical ventilation (OR = 1.61, 95% CI = 1.12-2.33), carbapenem antibiotic (OR = 1.71, 95% CI = 1.07-2.75), kidney disease (OR = 1.74, 95% CI = 1.04-2.90),and diabetes (OR = 1.83, 95% CI = 1.05-3.21). CONCLUSIONS: These findings help identify high-risk patients and guide AAD and CDAD prevention in critical care.