Epidemiology of diarrheagenic pathogens in acute hospitals in Singapore: a retrospective multicenter study

Acute infectious diarrhea imposes a substantial socioeconomic burden globally. In Singapore, information on etiological agents of diarrhea remains limited. Through analysis of data from public hospitals, this study presents key insights into the epidemiology of diarrheagenic pathogens. Two datasets comprising gastrointestinal multiplex polymerase chain reaction (PCR) panel results from adult and pediatric populations, drawn from five hospitals across several years, were collated. Stool samples included in the study were screened for 22 pathogens using a commercial PCR assay. Overall sample positivity, pathogen relative abundances, and co-detection rate were determined. Potential associations between co-detected pathogens were assessed via pairwise correlations. Additionally, exploratory analysis was undertaken to investigate seasonal patterns and climatic influence on pathogen detection. Sample positivity was 42.6% (3,212/7,543) in the adult data set and 52.1% (1,572/3,015) in the pediatric data set. Despite differences in ranking, the most frequently detected organisms in both groups were pathogenic Escherichia coli, Clostridioides difficile, Salmonella, and Norovirus. Differences in pathogen proportions between data sets reveal distinct epidemiological profiles in adults and children. Geographic variations in the prevalence of pathogens such as Plesiomonas shigelloides and Vibrio underscore the influence of climate change on infectious disease transmission. Co-detection of two or more organisms occurred in 14.7% of adult samples. Pathogen detections peaked in the warmer, drier mid-year months. This study highlights the significant contribution of non-notifiable pathogens to acute diarrhea burden, contextualizing local data within global epidemiological trends. Our findings carry important implications for clinical decision-making, public health policy, One Health disease prioritization, and optimization of surveillance strategies.IMPORTANCEAcute infectious diarrhea remains a major global health issue, yet in many cases, specific etiologies are often undiagnosed or underreported. This study uses multiplex PCR panel testing to identify a broad spectrum of diarrheal pathogens from thousands of patients across public hospitals, offering one of the most comprehensive assessments in the Southeast Asian region to date. It highlights the potentially overlooked role of non-notifiable pathogens and reveals distinct epidemiological patterns in adult and pediatric populations. Furthermore, it uncovers seasonal trends and potential links between climate and disease transmission. These findings fill critical knowledge gaps, improving clinical decision-making and strengthening public health responses. Our study supports the integration of environmental and epidemiological data to optimize health planning and offers useful insights for enhancing national surveillance strategies under a One Health approach.