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.