Epidemiology of Severe Acute Diarrhea in Patients Requiring Hospital Admission

Information on the epidemiology and susceptibility patterns of main pathogens causing severe acute diarrhea may help to reduce inappropriate antimicrobial use in emergency departments.

We sought to investigate the micro-organisms causing severe acute diarrhea in patients requiring hospital admission by means of a commercial multiple polymerase chain reaction system.

Between November 2016 and October 2018 we studied 132 patients with acute diarrhea who required hospital admission at a 250-bed hospital in Spain. Demographic, clinical, analytical, and microbiological data were collected from the medical records. Stool samples were processed using a rapid commercial multiple polymerase chain reaction system (FilmArray Gastrointestinal Panel), stool culture, and standard microbiological procedures.

The median age (range) of patients was 45.5 (0.1-92) years, and 50% were male; 46.2% presented with fever, 62.8% presented with vomiting, and 12.9% presented with rectal bleeding. At least 1 enteric pathogen was identified in 93 (70.4%) patients; 28 (21.2%) patients had >1 micro-organism. FilmArray Gastrointestinal Panel results were available in a median (range) of 1 (0-3) days. The micro-organisms most frequently identified were 24 cases of Campylobacter species, 20 cases of Clostridioides difficile producing toxin A or toxin B, 20 cases of Salmonella species, 12 cases of rotavirus, and 30 cases of different types of pathogenic Escherichia coli. Among the cases of C. difficile, 12 (60%) were community-acquired and 8 (40%) had an undetermined origin.

The FilmArray Gastrointestinal Panel system provides fast and reliable results and could be useful to select the most appropriate antimicrobial based on local susceptibilities until the results of the cultures are available.