Original Contributions| Volume 57, ISSUE 3, P290-298, September 2019

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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rivière M.
        • Baroux N.
        • Bousquet V.
        • Ambert-Balay K.
        • Beaudeau P.
        • Jourdan-Da Silva N.
        • et al.
        Secular trends in incidence of acute gastroenteritis in general practice, France, 1991 to 2015.
        Euro Surveill. 2017; 22: 1-8
        • Gangarosa R.E.
        • Glass R.I.
        • Lew J.F.
        • Boring J.R.
        Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly.
        Am J Epidemiol. 1992; 135: 281-290
        • Riddle M.S.
        • DuPont H.L.
        • Connor B.A.
        ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults.
        Am J Gastroenterol. 2016; 111: 602-622
        • Guerrant R.L.
        • Van Gilder T.
        • Steiner T.S.
        • Thielman N.M.
        • Slutsker L.
        • Tauxe R.V.
        • et al.
        Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea.
        Clin Infect Dis. 2001; 32: 331-351
        • Loosli J.
        • Gyr K.
        • Stalder H.
        • Stalder G.A.
        • Vischer W.
        • Voegtlin J.
        • et al.
        Etiology of acute infectious diarrhea in a highly industrialized area of Switzerland.
        Gastroenterology. 1985; 88: 75-79
        • Jewkes J.
        • Larson H.E.
        • Price A.B.
        • Sanderson P.J.
        • Davies H.A.
        Etiology of acute diarrhea in adults.
        Gut. 1981; 22: 388-392
        • Bresee J.S.
        • Marcus R.
        • Venezia R.A.
        • Keene W.E.
        • Morse D.
        • Thanassi M.
        • et al.
        The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States.
        J Infect Dis. 2012; 205: 1374-1381
        • García-Lechuz Moya J.M.
        • González López J.J.
        • Orta Mira N.
        • Sánchez Romero M.I.
        Recogida, transporte y procesamiento general de las muestras en el Laboratorio de Microbiología. 2017. 1b. Sánchez Romero MI (coordinadora). Procedimientos en Microbiología Clínica. Cercenado Mansilla E, Cantón Moreno R (editores). Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC).
        (Available at:)
        • Ofori E.
        • Ramai D.
        • Dhawan M.
        • Mustafa F.
        • Gasperino J.
        • Reddy M.
        Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies.
        J Hosp Infect. 2018; 99: 436-442
        • Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group
        KDIGO Clinical Practice Guideline for Acute Kidney Injury.
        (Available at:)
        • Porter C.K.
        • Riddle M.S.
        • Alcala A.N.
        • Sack D.A.
        • Harro C.
        • Chakraborty S.
        • et al.
        An evidenced-based scale of disease severity following human challenge with enteroxigenic Escherichia coli.
        PLoS One. 2016; 11: e0149358
        • Cohen S.H.
        • Gerding D.N.
        • Johnson S.
        • Kelly C.P.
        • Loo V.G.
        • McDonald L.C.
        • et al.
        Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).
        Infect Control Hosp Epidemiol. 2010; 31: 431-455
        • Piralla A.
        • Lunghi G.
        • Ardissino G.
        • Girello A.
        • Premoli M.
        • Bava E.
        • et al.
        FilmArray™ GI panel performance for the diagnosis of acute gastroenteritis or hemorrhagic diarrhea.
        BMC Microbiol. 2017; 17: 111
        • Spina A.
        • Kerr K.G.
        • Cormican M.
        • Barbut F.
        • Eigentler A.
        • Zerva L.
        • et al.
        Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis.
        Clin Microbiol Infect. 2015; 21: 719-728
        • European Centre for Disease Prevention and Control
        Campylobacteriosis - annual epidemiological report for 2017.
        (Available at:)
        • Post A.
        • Martiny D.
        • van Waterschoot N.
        • Hallin M.
        • Maniewski U.
        • Bottieau E.
        • et al.
        Antibiotic susceptibility profiles among Campylobacter isolates obtained from international travelers between 2007 and 2014.
        Eur J Clin Microbiol Infect Dis. 2017; 36: 2101-2107
        • Sáenz Y.
        • Zarazaga M.
        • Lantero M.
        • Gastanares M.J.
        • Baquero F.
        • Torres C.
        Antibiotic resistance in Campylobacter strains isolated from animals, foods, and humans in Spain in 1997-1998.
        Antimicrob Agents Chemother. 2000; 44: 267-271
        • Martín-Pozo A.
        • Arana D.M.
        • Fuentes M.
        • Alós J.I.
        Susceptibility to azithromycin and other antibiotics in recent isolates of Salmonella, Shigella and Yersinia.
        Enferm Infecc Microbiol Clin. 2014; 32: 369-371
        • Frenck Jr., R.W.
        • Nakhla I.
        • Sultan Y.
        • Bassily S.B.
        • Girgis Y.F.
        • David J.
        • et al.
        Azithromycin versus ceftriaxone for the treatment of uncomplicated typhoid fever in children.
        Clin Infect Dis. 2000; 31: 1134-1138
        • Thompson C.N.
        • Karkey A.
        • Dongol S.
        • Arjyal A.
        • Wolbers M.
        • Darton T.
        • et al.
        Treatment response in enteric fever in an era of increasing antimicrobial resistance: an individual patient data analysis of 2092 participants enrolled into 4 randomized, controlled trials in Nepal.
        Clin Infect Dis. 2017; 64: 1522-1531
        • Day M.
        • Doumith M.
        • Jenkins C.
        • Dallman T.J.
        • Hopkins K.L.
        • Elson R.
        • et al.
        Antimicrobial resistance in Shiga toxin-producing Escherichia coli serogroups O157 and O26 isolated from human cases of diarrhoeal disease in England, 2015.
        J Antimicrob Chemother. 2017; 72: 145-152
        • Jansen A.
        • Stark K.
        • Kunkel J.
        • Schreier E.
        • Ignatius R.
        • Liesenfeld O.
        • et al.
        Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study.
        BMC Infect Dis. 2008; 8: 143
        • McDonald L.C.
        • Gerding D.N.
        • Johnson S.
        • Bakken J.S.
        • Carroll K.C.
        • Coffin S.E.
        • et al.
        Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).
        Clin Infect Dis. 2018; 66: 987-994