title: Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli O157:H7 and other enteropathogens.
abstract: Escherichia coli O157:H7 and other Shiga toxin-producing E. coli (STEC) infections have been associated with bloody diarrhea. The prevalence of enteropathogens among patients with bloody diarrhea was determined by a prospective study at 11 US emergency departments. Eligible patients had bloody stools, > or =3 loose stool samples per 24-h period, and an illness lasting <7 days. Among 873 patients with 877 episodes of bloody diarrhea, stool samples for culture were obtained in 549 episodes (62.6%). Stool cultures were more frequently ordered for patients with fever, >10 stools/day, and visibly bloody stools than for patients without these findings. Enteropathogens were identified in 168 episodes (30.6%): Shigella (15.3%), Campylobacter (6.2%), Salmonella (5.8%), STEC (2.6%), and other (1.6%). Enteropathogens were isolated during 12.5% of episodes that physicians thought were due to a noninfectious cause. The prevalence of STEC infection varied by site from 0% to 6.2%. Hospital admissions resulted from 195 episodes (23.4%). These data support recommendations that stool samples be cultured for patients with acute bloody diarrhea.
authors.affiliation: Department of Emergency Medicine, Olive View--UCLA Los Angeles Medical Center, University of California, Los Angeles, Sylmar, CA 91342, USA. idnet@ucla.edu
authors.forename: D
authors.initials: D
authors.lastname: Talan
authors.forename: G J
authors.initials: GJ
authors.lastname: Moran
authors.forename: M
authors.initials: M
authors.lastname: Newdow
authors.forename: S
authors.initials: S
authors.lastname: Ong
authors.forename: W R
authors.initials: WR
authors.lastname: Mower
authors.forename: J Y
authors.initials: JY
authors.lastname: Nakase
authors.forename: R W
authors.initials: RW
authors.lastname: Pinner
authors.forename: L
authors.initials: L
authors.lastname: Slutsker
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D003967:Diarrhea / Q000382:microbiology*; D004636:Emergency Service, Hospital; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000145:classification / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D014481:United States
chemical_list: D003470:Culture Media