Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - A prospective observational multicentre study

Florence Skyum*, Court Pedersen, Vibeke Andersen, Ming Chen, Andreas Franke, Detlev Petersen, Wolfgang Ries, Christian Backer Mogensen

*Kontaktforfatter for dette arbejde

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Resumé

Background: Infectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement are sufficient, and to identify information that might be used to identify patients requiring isolation. Methods: Prospective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria. Results: The study enrolled 227 patients, of whom 163 (71%) delivered a faecal sample for Norovirus analysis (13% positive), 171 (74%) for C. difficile (13% positive), and 173 (76%) for enteropathogenic bacteria (16% positive). In total 71% of the patients were isolated using strict precautions, 29% of the isolated patient and 14% of the patients who were not isolated had had a highly contagious GE. Risk factors for Norovirus included frequent vomiting (OR 5.5), recent admission of another patient with Norovirus (OR 2.6), and a short duration of diarrhoea. Risk factors for C. difficile infections included older age (OR 6.0), longer duration of diarrhoea (OR 5.2), mucus in stool (OR 3.5), and previous antibiotic use (OR 23.4). Conclusion: Highly contagious GE occurs in of the GE patients in the EDs, isolation based on clinical judgement is not very efficient. Several risk factors can predict the presence of Norovirus or toxigenic Clostridium difficile. It is uncertain whether this knowledge can improve isolation practices in ED settings. Trial registration: This study was retrospectively registered in the Clinical Trials Data Base (NCT02685527) and prospectively approved by the Regional Committees on Health Research Ethics for Southern Denmark (project ID S20140200) and Ethics Committee at the Medical Association of Schleswig-Holstein ["Ethikkommission bei der Ärztekammer Schleswig-Holstein", project ID 120/15(I)] and registered with the Danish Data Protection Agency (project ID nr. 2008-58-0035/ 1608).

OriginalsprogEngelsk
Artikelnummer133
TidsskriftBMC Infectious Diseases
Vol/bind19
Antal sider11
ISSN1471-2334
DOI
StatusUdgivet - 11. feb. 2019

Fingeraftryk

Gastroenteritis
Clostridium difficile
Multicenter Studies
Hospital Emergency Service
Patient Isolation
Research Ethics
Computer Security
Ethics Committees
Vital Signs
Patient Admission
Denmark
Mucus
Clinical Trials
Databases
Health

Citer dette

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title = "Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - A prospective observational multicentre study",
abstract = "Background: Infectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement are sufficient, and to identify information that might be used to identify patients requiring isolation. Methods: Prospective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria. Results: The study enrolled 227 patients, of whom 163 (71{\%}) delivered a faecal sample for Norovirus analysis (13{\%} positive), 171 (74{\%}) for C. difficile (13{\%} positive), and 173 (76{\%}) for enteropathogenic bacteria (16{\%} positive). In total 71{\%} of the patients were isolated using strict precautions, 29{\%} of the isolated patient and 14{\%} of the patients who were not isolated had had a highly contagious GE. Risk factors for Norovirus included frequent vomiting (OR 5.5), recent admission of another patient with Norovirus (OR 2.6), and a short duration of diarrhoea. Risk factors for C. difficile infections included older age (OR 6.0), longer duration of diarrhoea (OR 5.2), mucus in stool (OR 3.5), and previous antibiotic use (OR 23.4). Conclusion: Highly contagious GE occurs in of the GE patients in the EDs, isolation based on clinical judgement is not very efficient. Several risk factors can predict the presence of Norovirus or toxigenic Clostridium difficile. It is uncertain whether this knowledge can improve isolation practices in ED settings. Trial registration: This study was retrospectively registered in the Clinical Trials Data Base (NCT02685527) and prospectively approved by the Regional Committees on Health Research Ethics for Southern Denmark (project ID S20140200) and Ethics Committee at the Medical Association of Schleswig-Holstein [{"}Ethikkommission bei der {\"A}rztekammer Schleswig-Holstein{"}, project ID 120/15(I)] and registered with the Danish Data Protection Agency (project ID nr. 2008-58-0035/ 1608).",
keywords = "Clostridium difficile, Contact precautions, Emergency department, Isolation procedures, Norovirus, Prospective Studies, Humans, Middle Aged, Male, Caliciviridae Infections/diagnosis, Norovirus/isolation & purification, Young Adult, Time Factors, Aged, 80 and over, Patient Isolation, Adult, Female, Retrospective Studies, Emergency Service, Hospital, Enterocolitis, Pseudomembranous/diagnosis, Risk Factors, Diarrhea/complications, Travel, Adolescent, Denmark, Aged, Clostridium difficile/isolation & purification, Gastroenteritis/diagnosis, Anti-Bacterial Agents/adverse effects",
author = "Florence Skyum and Court Pedersen and Vibeke Andersen and Ming Chen and Andreas Franke and Detlev Petersen and Wolfgang Ries and Mogensen, {Christian Backer}",
year = "2019",
month = "2",
day = "11",
doi = "10.1186/s12879-019-3754-4",
language = "English",
volume = "19",
journal = "B M C Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - A prospective observational multicentre study. / Skyum, Florence; Pedersen, Court; Andersen, Vibeke; Chen, Ming; Franke, Andreas; Petersen, Detlev; Ries, Wolfgang; Mogensen, Christian Backer.

I: BMC Infectious Diseases, Bind 19, 133, 11.02.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - A prospective observational multicentre study

AU - Skyum, Florence

AU - Pedersen, Court

AU - Andersen, Vibeke

AU - Chen, Ming

AU - Franke, Andreas

AU - Petersen, Detlev

AU - Ries, Wolfgang

AU - Mogensen, Christian Backer

PY - 2019/2/11

Y1 - 2019/2/11

N2 - Background: Infectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement are sufficient, and to identify information that might be used to identify patients requiring isolation. Methods: Prospective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria. Results: The study enrolled 227 patients, of whom 163 (71%) delivered a faecal sample for Norovirus analysis (13% positive), 171 (74%) for C. difficile (13% positive), and 173 (76%) for enteropathogenic bacteria (16% positive). In total 71% of the patients were isolated using strict precautions, 29% of the isolated patient and 14% of the patients who were not isolated had had a highly contagious GE. Risk factors for Norovirus included frequent vomiting (OR 5.5), recent admission of another patient with Norovirus (OR 2.6), and a short duration of diarrhoea. Risk factors for C. difficile infections included older age (OR 6.0), longer duration of diarrhoea (OR 5.2), mucus in stool (OR 3.5), and previous antibiotic use (OR 23.4). Conclusion: Highly contagious GE occurs in of the GE patients in the EDs, isolation based on clinical judgement is not very efficient. Several risk factors can predict the presence of Norovirus or toxigenic Clostridium difficile. It is uncertain whether this knowledge can improve isolation practices in ED settings. Trial registration: This study was retrospectively registered in the Clinical Trials Data Base (NCT02685527) and prospectively approved by the Regional Committees on Health Research Ethics for Southern Denmark (project ID S20140200) and Ethics Committee at the Medical Association of Schleswig-Holstein ["Ethikkommission bei der Ärztekammer Schleswig-Holstein", project ID 120/15(I)] and registered with the Danish Data Protection Agency (project ID nr. 2008-58-0035/ 1608).

AB - Background: Infectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement are sufficient, and to identify information that might be used to identify patients requiring isolation. Methods: Prospective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria. Results: The study enrolled 227 patients, of whom 163 (71%) delivered a faecal sample for Norovirus analysis (13% positive), 171 (74%) for C. difficile (13% positive), and 173 (76%) for enteropathogenic bacteria (16% positive). In total 71% of the patients were isolated using strict precautions, 29% of the isolated patient and 14% of the patients who were not isolated had had a highly contagious GE. Risk factors for Norovirus included frequent vomiting (OR 5.5), recent admission of another patient with Norovirus (OR 2.6), and a short duration of diarrhoea. Risk factors for C. difficile infections included older age (OR 6.0), longer duration of diarrhoea (OR 5.2), mucus in stool (OR 3.5), and previous antibiotic use (OR 23.4). Conclusion: Highly contagious GE occurs in of the GE patients in the EDs, isolation based on clinical judgement is not very efficient. Several risk factors can predict the presence of Norovirus or toxigenic Clostridium difficile. It is uncertain whether this knowledge can improve isolation practices in ED settings. Trial registration: This study was retrospectively registered in the Clinical Trials Data Base (NCT02685527) and prospectively approved by the Regional Committees on Health Research Ethics for Southern Denmark (project ID S20140200) and Ethics Committee at the Medical Association of Schleswig-Holstein ["Ethikkommission bei der Ärztekammer Schleswig-Holstein", project ID 120/15(I)] and registered with the Danish Data Protection Agency (project ID nr. 2008-58-0035/ 1608).

KW - Clostridium difficile

KW - Contact precautions

KW - Emergency department

KW - Isolation procedures

KW - Norovirus

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Caliciviridae Infections/diagnosis

KW - Norovirus/isolation & purification

KW - Young Adult

KW - Time Factors

KW - Aged, 80 and over

KW - Patient Isolation

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Emergency Service, Hospital

KW - Enterocolitis, Pseudomembranous/diagnosis

KW - Risk Factors

KW - Diarrhea/complications

KW - Travel

KW - Adolescent

KW - Denmark

KW - Aged

KW - Clostridium difficile/isolation & purification

KW - Gastroenteritis/diagnosis

KW - Anti-Bacterial Agents/adverse effects

U2 - 10.1186/s12879-019-3754-4

DO - 10.1186/s12879-019-3754-4

M3 - Journal article

VL - 19

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

SN - 1471-2334

M1 - 133

ER -