Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016-2018.
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
02 11 2021
02 11 2021
Historique:
received:
31
01
2020
pubmed:
26
6
2020
medline:
11
11
2021
entrez:
26
6
2020
Statut:
ppublish
Résumé
Acute gastroenteritis (AGE) burden, etiology, and severity in adults is not well characterized. We implemented a multisite AGE surveillance platform in 4 Veterans Affairs Medical Centers (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California), collectively serving >320 000 patients annually. From 1 July 2016 to 30 June 2018, we actively identified inpatient AGE case patients and non-AGE inpatient controls through prospective screening of admitted patients and passively identified outpatients with AGE through stool samples submitted for clinical diagnostics. We abstracted medical charts and tested stool samples for 22 pathogens by means of multiplex gastrointestinal polymerase chain reaction panel followed by genotyping of norovirus- and rotavirus-positive samples. We determined pathogen-specific prevalence, incidence, and modified Vesikari severity scores. We enrolled 724 inpatients with AGE, 394 non-AGE inpatient controls, and 506 outpatients with AGE. Clostridioides difficile and norovirus were most frequently detected among inpatients (for AGE case patients vs controls: C. difficile, 18.8% vs 8.4%; norovirus, 5.1% vs 1.5%; P < .01 for both) and outpatients (norovirus, 10.7%; C. difficile, 10.5%). The incidence per 100 000 population was highest among outpatients (AGE, 2715; C. difficile, 285; norovirus, 291) and inpatients ≥65 years old (AGE, 459; C. difficile, 91; norovirus, 26). Clinical severity scores were highest for inpatient norovirus, rotavirus, and Shigella/enteroinvasive Escherichia coli cases. Overall, 12% of inpatients with AGE had intensive care unit stays, and 2% died; 3 deaths were associated with C. difficile and 1 with norovirus. C. difficile and norovirus were detected year-round with a fall/winter predominance. C. difficile and norovirus were leading AGE pathogens in outpatient and hospitalized US veterans, resulting in severe disease. Clinicians should remain vigilant for bacterial and viral causes of AGE year-round.
Sections du résumé
BACKGROUND
Acute gastroenteritis (AGE) burden, etiology, and severity in adults is not well characterized. We implemented a multisite AGE surveillance platform in 4 Veterans Affairs Medical Centers (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California), collectively serving >320 000 patients annually.
METHODS
From 1 July 2016 to 30 June 2018, we actively identified inpatient AGE case patients and non-AGE inpatient controls through prospective screening of admitted patients and passively identified outpatients with AGE through stool samples submitted for clinical diagnostics. We abstracted medical charts and tested stool samples for 22 pathogens by means of multiplex gastrointestinal polymerase chain reaction panel followed by genotyping of norovirus- and rotavirus-positive samples. We determined pathogen-specific prevalence, incidence, and modified Vesikari severity scores.
RESULTS
We enrolled 724 inpatients with AGE, 394 non-AGE inpatient controls, and 506 outpatients with AGE. Clostridioides difficile and norovirus were most frequently detected among inpatients (for AGE case patients vs controls: C. difficile, 18.8% vs 8.4%; norovirus, 5.1% vs 1.5%; P < .01 for both) and outpatients (norovirus, 10.7%; C. difficile, 10.5%). The incidence per 100 000 population was highest among outpatients (AGE, 2715; C. difficile, 285; norovirus, 291) and inpatients ≥65 years old (AGE, 459; C. difficile, 91; norovirus, 26). Clinical severity scores were highest for inpatient norovirus, rotavirus, and Shigella/enteroinvasive Escherichia coli cases. Overall, 12% of inpatients with AGE had intensive care unit stays, and 2% died; 3 deaths were associated with C. difficile and 1 with norovirus. C. difficile and norovirus were detected year-round with a fall/winter predominance.
CONCLUSIONS
C. difficile and norovirus were leading AGE pathogens in outpatient and hospitalized US veterans, resulting in severe disease. Clinicians should remain vigilant for bacterial and viral causes of AGE year-round.
Identifiants
pubmed: 32584956
pii: 5862655
doi: 10.1093/cid/ciaa806
pmc: PMC9195496
mid: NIHMS1808869
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2729-e2738Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Organisme : the Emory Center for AIDS Research
Organisme : Atlanta VAMC
Organisme : CDC HHS
Pays : United States
Informations de copyright
Published by Oxford University Press for the Infectious Diseases Society of America 2020.
Références
J Infect Dis. 2013 Apr;207(7):1058-65
pubmed: 23300161
MMWR Surveill Summ. 2015 Dec 11;64(12):1-16
pubmed: 26656915
Clin Infect Dis. 2011 Feb 15;52(4):466-74
pubmed: 21258098
Lancet Infect Dis. 2017 Sep;17(9):909-948
pubmed: 28579426
PLoS One. 2020 Jan 14;15(1):e0227890
pubmed: 31935271
Clin Infect Dis. 2018 Mar 19;66(7):987-994
pubmed: 29562266
Aging health. 2013 Aug 1;9(4):403-414
pubmed: 24955106
Clin Infect Dis. 2020 Jan 1;70(1):40-48
pubmed: 30901024
Clin Infect Dis. 2012 Jul;55(2):216-23
pubmed: 22491338
J Infect. 2015 Jun;70(6):683-7
pubmed: 25481405
BMC Nephrol. 2018 Nov 1;19(1):303
pubmed: 30384836
Infect Dis Clin North Am. 2017 Dec;31(4):839-870
pubmed: 28911830
N Engl J Med. 2013 Mar 21;368(12):1121-30
pubmed: 23514289
Open Forum Infect Dis. 2018 Jul 19;5(8):ofy175
pubmed: 30327788
Emerg Infect Dis. 2011 Jan;17(1):16-22
pubmed: 21192849
PLoS One. 2017 Dec 7;12(12):e0189227
pubmed: 29216276
J Clin Microbiol. 2017 Jul;55(7):2208-2221
pubmed: 28490488
PLoS One. 2015 May 21;10(5):e0126733
pubmed: 25996826
Emerg Infect Dis. 2011 Aug;17(8):1381-8
pubmed: 21801613
J Infect Dis. 2013 Sep 1;208(5):790-800
pubmed: 23757337
Emerg Infect Dis. 2013 Aug;19(8):1198-205
pubmed: 23876403
PLoS One. 2016 Apr 26;11(4):e0148395
pubmed: 27115485
Vaccine. 2019 Nov 28;37(50):7300-7306
pubmed: 30902484
Expert Rev Vaccines. 2018 Sep;17(9):773-784
pubmed: 30092671
J Infect Dis. 2016 Sep 1;214(5):732-8
pubmed: 27302190
Open Forum Infect Dis. 2019 Mar 06;6(4):ofz115
pubmed: 30949545
J Clin Microbiol. 2015 Feb;53(2):373-81
pubmed: 24989606
PeerJ. 2016 Jan 11;4:e1560
pubmed: 26839745
N Engl J Med. 2015 Feb 26;372(9):825-34
pubmed: 25714160