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Background:
The causative pathogen is rarely identified in the emergency department (ED), since the results of cultures are usually unavailable. As a result, antimicrobial treatment may be overused. The aim of our study was to investigate the pathogens, risk factors of acute gastroenteritis, and predictors of acute bacterial gastroenteritis in the...
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Context 1
... statistically significant in the multi- variable model. Factors significantly associated with bacterial gastro- enteritis based on univariate analysis are presented in Table 6. According to our results from the final multivariable logistic analysis, four variables were found to have statistically significant associations with the bacterial gastroenteritis cases: presence of fecal leukocytes (adjusted OR 2.08; 95% CI, 1.42-3.05), ...
Citations
... AGE is characterized by diarrhea and/or vomiting, frequently accompanied by nausea, fever, abdominal pain, and dehydration, and is a common cause of hospital admission, with >1 million hospitalizations annually in the United States [3,4]. Viral pathogens, especially noroviruses, are the leading cause of AGE in adults and can cause severe disease [5,6]. In the United States, noroviruses cause ∼110 000 hospitalizations and 900 deaths each year [7]. ...
... A recent evaluation of SUPERNOVA data found norovirus to be the second leading cause of AGE after Clostridiodes difficile among hospitalized adults, and a higher incidence of AGE and norovirus-associated AGE was seen among adults aged ≥65 years compared with those aged <65 years [9]. Demographic and exposure characteristics have been evaluated as potential risk factors for AGE in the past, but data on underlying medical conditions as risk factors for AGE are limited [6,[11][12][13]. To address this gap and understand the factors driving both disease burden and severity, we aimed to identify demographics, behavioral and exposure factors, and underlying medical conditions associated with increased risk for all-cause AGE, norovirus-associated AGE, and severe AGE among hospitalized adults. ...
... Our findings are consistent with prior evidence that close contact with an ill person having diarrhea or vomiting is a risk factor for all-cause AGE and norovirus-associated AGE [6,13,[17][18][19]. We found that individuals who had contact with a person with AGE within their household had a 2-fold higher odds of all-cause AGE compared with non-AGE controls, and individuals exposed to a person with AGE either inside or outside their household were found to have 4-5-fold higher odds of having norovirus-associated AGE. ...
Background
In the United States, approximately 179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated versus non-norovirus AGE, and severe versus mild/moderate AGE among hospitalized adults.
Methods
We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016–November 30, 2019 at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size.
Results
Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio (aOR) 5.6, 95% confidence interval (CI) 2.7-11.7), human immunodeficiency virus (HIV) infection (aOR 3.9, 95% CI 1.8-8.5), severe renal disease (aOR 3.1, 95% CI 1.8-5.2), and household contact with a person with AGE (aOR 2.9, 95% CI 1.3-6.7). Household (OR 4.4, 95% CI 1.6-12.0) and non-household contact (OR 5.0, 95% CI 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR 3.4, 95% CI:1.3-8.8) was significantly associated with severe AGE.
Conclusions
Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions such as norovirus vaccines, to specific high-risk populations.
... Acute gastroenteritis has been a public health problem in developing countries partly because of poor access to clean and safe water and inadequately treated sewage discharges. It has been reported that the presence of faecal leukocytes, frequent diarrhoea, and eating of crabs and shrimps are highly associated with bacterial gastroenteritis [12]. According to the WHO [13] the greatest risk associated with the ingestion of water is the microbial risk due to water contamination by sewage that contains enteric pathogens and viruses. ...
... Acute gastroenteritis has been a public health problem in developing countries partly because of poor access to clean and safe water and inadequately treated sewage discharges. It has been reported that the presence of faecal leukocytes, frequent diarrhoea, and eating of crabs and shrimps are highly associated with bacterial gastroenteritis [12]. According to the WHO [13] the greatest risk associated with the ingestion of water is the microbial risk due to water contamination by sewage that contains enteric pathogens and viruses. ...
... They were from four babies who had clinical conditions suggesting GI bleeding; one baby (gestational age (GA) of 32 weeks and 5 days) who showed FIT FIT Tf might be attributed to the higher stability of Tf and resistance to digestive enzymes and bacterial degradation [7]. A bloody stool can be seen in bacterial diarrhea but not in viral diarrhea [1], and therefore, FOBT may aid clinicians in the identification of patients requiring hospitalization [14], pathogen testing, and initiation of optimal antibiotic therapy. Further evaluation using FIT Tf involving enterocolitis of various causes is needed. ...
Background: Gastrointestinal (GI) bleeding can result
from various conditions, including ulcers, neoplasms
and infectious enterocolitis. The aim of this study
was to evaluate the utility of the fecal immunochemical
transferrin test compared with the fecal Hb test
in various clinical settings.Methods: A total of 1,116 clinical stool specimens
submitted for fecal occult blood testing were prospectively
examined using both FIT Hb and FIT Tf
kits (AlfresaPharma, Japan). To verify the specificity
of the two tests, stool specimens from 265 health
check-up examinees were also included.Results: A review of medical records revealed that
396 patients had clinical conditions associated with
GI bleeding. FIT Hb and FIT Tf results were positive
in 156 (39.4%) and 137 (34.6%) cases, respectively,
and an additional 194 (49.0%) cases tested positive
with either FIT Hb or FIT Tf. The two tests showed a
moderate strength of agreement (kappa value; 0.56).
Colitis (n=71) was associated with the most GI bleedings,
followed by acute gastroenteritis (n=29), GI ulcers
(n=27) and GI cancers (n=15). While the first
two groups had higher positive rates on FIT Tf, patients
in the latter two groups had higher positive
rates on FIT Hb. Notably, four of nine specimens
from premature babies tested positive only on FIT Tf.
The specificity of FIT Hb and FIT Tf was 100% and
99.6%, respectively.Conclusion: Concurrent use of FIT Hb and FIT Tf improved
the detection rate of occult GI bleeding, especially
in patients with infectious GI disease (such as
colitis or gastroenteritis) and in premature babies.
(Ann Clin Microbiol 2018;21:51-57)
... CUTE gastroenteritis is one of the commonly reported OPD case with viruses being the leading causative organism [1], [2]. Most of time the causative pathogens are seldom identified at the OPD due to delay in laboratory results or failure to obtain specimens before starting treatment [3]. Studies have shown that 71% of gastroenteritis cases at the OPD are foodborne related [4]- [7] with presentation such as diarrhea and/or vomiting, which is marked by the presence of OTB is the Head, Public Education and Foodborne Disease Surveillance, Food and Drugs Authority-Accra, Ghana (e-mail: otumfuo4@gmail.com). ...
... fever, abdominal pain, fecal leukocytes, and hemoccult. Most cases of acute gastroenteritis, like foodborne diseases are selflimiting [3], [8], hence are rarely reported in health facilities. ...
Abstract—Background: Acute gastroenteritis is one of the
frequently reported Out-Patient Department (OPD) cases. However,
the causative pathogens of these cases are rarely identified at the
OPD due to delay in laboratory results or failure to obtain specimens
before antibiotics is administered. Method: A retrospective review of
surveillance data from the Adentan Municipality, Accra, Ghana that
were recorded in the National foodborne disease surveillance system
of Ghana, was conducted with the main aim of describing the
epidemiology and food practice of cases reported from the Adentan
Municipality. The study involved a retrospective review of
surveillance data kept on patients who visited health facilities that are
involved in foodborne disease surveillance in Ghana, from January
2015 to December 2016. Results: A total of 375 cases were reviewed
and these were classified as viral hepatitis (hepatitis A and E),
cholera (Vibrio cholerae), dysentery (Shigella sp.), typhoid fever
(Salmonella sp.) or gastroenteritis. Cases recorded were all suspected
case and the average cases recorded per week was 3. Typhoid fever
and dysentery were the two main clinically diagnosed foodborne
illnesses. The highest number of cases were observed during the late
dry season (Feb to April), which marks the end of the dry season and
the beginning of the rainy season. Relatively high number of cases
was also observed during the late wet seasons (Jul to Oct) when the
rainfall is the heaviest. Home-made food and street vended food were
the major sources of suspected etiological food, recording 49.01%
and 34.87% of the cases respectively. Conclusion: Majority of cases
recorded were classified as gastroenteritis due to the absence of
laboratory confirmation. Few cases were classified as typhoid fever
and dysentery based on clinical symptoms presented. Patients
reporting with foodborne diseases were found to consume home meal
and street vended foods as their predominant source of food.
... Our isolation rate falls within the range of 27.9-55.1% reported by similar studies done in Iran, 4,10,15 and exceeds those done in other countries (4.8-26.8%). 13,[32][33][34] In this study, DEC (48 isolates; 43.6%) and Shigella species (41 isolates; 37.3%) turned out to be the most prevalent etiological agents causing acute diarrhea. This was in agreement with the findings in previous studies carried out in Iran, in which DEC and/or Shigella species were the most common bacterial enteric pathogens (30.4-54%). ...
This study was conducted to find the etiology of acute diarrhea in Iranian children and determine the antimicrobial resistance patterns. The pathogenic bacteria were recovered from 110/269 (40.9%) diarrheal fecal samples with the following profiles: the most predominant pathogen was diarrheagenic Escherichia coli (DEC) (43.6%), comprising enteroaggregative E. coli (23.6%), enteropathogenic E. coli (10.9%), enteroinvasive E. coli (5.5%), and enterotoxigenic E. coli (3.6%); Shigella spp. (37.3%), Salmonella spp. (12.7%) and Campylobacter jejuni (6.4%) were ranked second and fourth in terms of prevalence, respectively. The rates of extended-spectrum beta-lactamase (ESBL) production were 66.7% and 53.7% in DEC and Shigella, respectively. Resistance to ampicillin (AMP) (95.1%), trimethoprim/sulfamethoxazole (SXT) (73.2%), azithromycin (ATH) (21.9%), and ciprofloxacin (CIP) (14.6%) was observed among Shigella isolates. Multidrug resistance phenotype was observed in 24.4% (10/41) of Shigella isolates, with the most common pattern of resistance to cefotaxime, ceftriaxone, ceftazidime, AMP, SXT, and ATH. This study indicates an alarming increase in the ESBL production of DEC and Shigella spp. and identifies them as the two most prevalent diarrhea-causing enteropathogens in the region. The results show that CIP could be an alternative to third-generation cephalosporins against these two pathogens. Therefore, it is proposed that further investigation be done in the pursuit of alternative antibiotics that are effective against the resistant cases. For instance, one study could look into the comparative clinical effectiveness of third-generation cephalosporins versus CIP, the latter not being presently the drug of choice for the treatment of acute diarrhea in children in Iran.
... Antibiotic treatment is suggested in patients with suspected invasive processes and severe diarrhea, systemic symptoms, fever or abdominal pain as well as in patients with toxic signs. Some studies have reported the association between the consumption of shrimp or crab and acute gastroenteritis with Escherichia coli, Vibrio spp, Aeromonas spp, Listeria monocytogenes, especially in developing countries with lower sanitation conditions [4]. ...
Despite the fact that acute gastroenteritis can be prevented, the disease still affects children, especially under the age of two. The increased levels of pediatric mortality in most developing regions make diarrheal diseases one of the most common causes of death in the children under the age of 5. The purpose of the study was to describe the cases of acute gastroenteritis reported as healthcare-associated infections in a pediatric hospital deserving the north-eastern urban and rural regions of Romania.
Material and methods:
A descriptive study was conducted on a group of 615 cases with acute bacterial gastroenteritis as healthcare-associated infections (HAIs), reported in "Sf. Maria" Emergency Hospital for Children, Iași, between 2012 and 2016.
Results:
Most cases of acute bacterial gastroenteritis were registered in 2015 (154 cases-25.04%), and the lowest in 2012 (12.84%). Male gender prevailed in almost all years of study, with no statistical significance (p≥0.05). Gastroenteritis with Campylobacter was most commonly reported in pediatric wards, especially in infants of 0-1 years old and children aged of 2-6 years. Cases of HAIs with Salmonella spp were also frequent.
Conclusions:
A competent management of HAIs especially as acute gastroenteritis in an emergency hospital for children from a region that includes developing rural areas, should be the most important issue for professionals involved in surveillance and control strategies, as well as clinicians, epidemiologist and microbiologist, in order to prevent HAIs burden occurrence and avoid antimicrobial resistance.
Background
The measurement of fecal inflammatory biomarkers among individuals presenting to care with diarrhea could improve the identification of bacterial diarrheal episodes that would benefit from antibiotic therapy. We reviewed prior literature in this area and describe our proposed methods to evaluate 4 biomarkers in the Enterics for Global Health (EFGH) Shigella surveillance study.
Methods
We systematically reviewed studies since 1970 from PubMed and Embase that assessed the diagnostic characteristics of inflammatory biomarkers to identify bacterial diarrhea episodes. We extracted sensitivity and specificity and summarized the evidence by biomarker and diarrhea etiology. In EFGH, we propose using commercial enzyme-linked immunosorbent assays to test for myeloperoxidase, calprotectin, lipocalin-2, and hemoglobin in stored whole stool samples collected within 24 hours of enrollment from participants in the Bangladesh, Kenya, Malawi, Pakistan, Peru, and The Gambia sites. We will develop clinical prediction scores that incorporate the inflammatory biomarkers and evaluate their ability to identify Shigella and other bacterial etiologies of diarrhea as determined by quantitative polymerase chain reaction (qPCR).
Results
Forty-nine studies that assessed fecal leukocytes (n = 39), red blood cells (n = 26), lactoferrin (n = 13), calprotectin (n = 8), and myeloperoxidase (n = 1) were included in the systematic review. Sensitivities were high for identifying Shigella, moderate for identifying any bacteria, and comparable across biomarkers. Specificities varied depending on the outcomes assessed. Prior studies were generally small, identified red and white blood cells by microscopy, and used insensitive gold standard diagnostics, such as conventional bacteriological culture for pathogen detection.
Conclusions
Our evaluation of inflammatory biomarkers to distinguish diarrhea etiologies as determined by qPCR will provide an important addition to the prior literature, which was likely biased by the limited sensitivity of the gold standard diagnostics used. We will determine whether point-of-care biomarker tests could be a viable strategy to inform treatment decision making and increase appropriate targeting of antibiotic treatment to bacterial diarrhea episodes.
Background: Diarrhea is among the common causes of morbidity and mortality in children. It is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). It does not include frequent passing of formed stool and passing of loose, pasty stools by breastfed babies. It is usually a symptom of an infection in the intestinal tract, caused by variety of organisms, which is spread through contaminated food or drinking water, or from person-to-person as a result of poor hygiene. Diarrhea can last several days and can leave the body without the water and salts that are necessary for survival causing significant number of mortality and morbidity among children. At the level of primary care, diagnosis, management and treatment of food-and waterborne-diseases, which commonly present as diarrhea, lack the necessary protocols and standards, thus, the creation of this clinical pathway. Objective: The main goal of this clinical pathway was to provide guidance to family and community physicians, and other primary care physicians in managing acute diarrhea among immunocompetent pediatric patients. Methods: ADAPTE process was used in CPG development. Existing guidelines on acute diarrhea among pediatric patients were retrieved and appraised using the AGREE II tool. Recommendation statements from the guidelines that passed the AGREE II tool were reviewed. Recommendation statements that will help answer the clinical questions posed in the creation of the clinical pathway were adapted. For clinical questions were not answered by the available guideline recommendations, a de novo method was conducted. The adapted recommendation statements and the supporting summary of evidences were sent for external review prior to consensus development. Suggestions provided in both steps were discussed and incorporated in the final manuscript, as appropriate. Key Recommendation Statements: These key recommendation statements addressing the clinical assessment, diagnosis, interventions (pharmacologic and non-pharmacologic), and patient outcomes that are relevant in the outpatient or primary care setting in the Philippines were based on the summarized key evidences from the systematic review of literature conducted using the ADAPTE process. Clinical Assessment • Recommendation 1. A focused medical history that includes questions on duration, frequency, characteristics, associated symptoms, consumption of raw, ill-prepared, or rotten food; intake of antibiotics, contaminated food or water; and history of travel should be obtained. (Strong recommendation, High quality evidence) • Recommendation 2. Physical examination should be done to assess the nutritional status, degree of dehydration, severity of disease, and presence of complications and comorbid conditions. (Strong recommendation, High quality evidence) • Recommendation 3. Degree of dehydration should be classified into No Dehydration, Mild to Moderate Dehydration, or Severe Dehydration. (Weak recommendation, Moderate quality evidence) • Recommendation 4. Children with acute infectious diarrhea who have any of the following conditions should be admitted to the hospital: severe dehydration, inability to tolerate fluids orally, suspected electrolyte abnormalities, altered consciousness, abdominal distention, respiratory distress, pneumonia, meningitis/encephalitis, sepsis, moderate to severe malnutrition, 354 THE FILIPINO FAMILY PHYSICIAN suspected surgical condition, or conditions for safe follow-up and home management are not met. (Strong recommendation, High quality evidence) Diagnostic Tests • Recommendation 5. Routine diagnostic tests are not necessary among children with acute diarrhea. (Strong recommendation, Low quality evidence) • Recommendation 6. Stool examination may only be requested if the patient present with moderate to severe condition, bloody diarrhea, or amoebiasis and parasitism is being considered at time of epidemic. (Strong recommendation, High quality evidence) • Recommendation 7. Diagnostic tests may be requested if concomitant conditions like pneumonia, urinary tract infection, sepsis or meningitis are suspected; or if abdominal distension is observed post-hydration. (Strong recommendation, High quality evidence) • Recommendation 8. Stool culture, serologic test, rapid diagnostic test, PCR determination and serum biomarkers are not recommended in family and community practice. (Strong recommendation, High quality evidence) Pharmacologic Treatment • Recommendation 9. Reduced osmolarity oral rehydration solution (ORS), commercial or home-made is recommended to replace previous and ongoing losses. (Strong recommendation, High quality evidence) • Recommendation 10. The volume and frequency of reduced osmolarity oral rehydration solution (ORS) should be dependent on patient's age or weight, severity of dehydration and ongoing losses. (Strong recommendation, High quality evidence) • Recommendation 11. Severe dehydration should be managed in the hospital with intravenous hydration. (Strong recommendation, High quality of evidence) • Recommendation 12. Routine empiric antibiotic treatment is not recommended in children with acute infectious diarrhea.
