title: Etiology and Risk Factors of Acute Gastroenteritis in a Taipei Emergency Department: Clinical Features for Bacterial Gastroenteritis.
abstract: BACKGROUND
  The causative pathogen is rarely identified in the emergency department (ED), since the results of cultures are usually unavailable. As a result, antimicrobial treatment may be overused. The aim of our study was to investigate the pathogens, risk factors of acute gastroenteritis, and predictors of acute bacterial gastroenteritis in the ED.
  
  
  METHODS
  We conducted a matched case-control study of 627 stool samples and 612 matched pairs.
  
  
  RESULTS
  Viruses (41.3%) were the leading cause of gastroenteritis, with noroviruses (32.2%) being the most prevalent, followed by bacteria (26.8%) and Giardia lamblia (12.4%). Taking antacids (adjusted odds ratio [aOR] 4.10; 95% confidence interval [CI], 2.57-6.53), household members/classmates with gastroenteritis (aOR 4.69; 95% CI, 2.76-7.96), attending a banquet (aOR 2.29; 95% CI, 1.64-3.20), dining out (aOR 1.70; 95% CI, 1.13-2.54), and eating raw oysters (aOR 3.10; 95% CI, 1.61-5.94) were highly associated with gastroenteritis. Elders (aOR 1.04; 05% CI, 1.02-1.05), those with CRP >10 mg/L (aOR 2.04; 95% CI, 1.15-3.62), or those who were positive for fecal leukocytes (aOR 2.04; 95% CI, 1.15-3.62) or fecal occult blood (aOR 1.97; 95% CI, 1.03-3.77) were more likely to be hospitalized in ED. In addition, presence of fecal leukocytes (time ratio [TR] 1.22; 95% CI, 1.06-1.41), abdominal pain (TR 1.20; 95% CI, 1.07-1.41), and frequency of vomiting (TR 0.79; 95% CI, 0.64-0.98) were significantly associated with the duration of acute gastroenteritis. Presence of fecal leukocytes (aOR 2.08; 95% CI, 1.42-3.05), winter season (aOR 0.45; 95% CI, 0.28-0.74), frequency of diarrhea (aOR 1.69; 95% CI, 1.01-2.83), and eating shrimp or crab (aOR 1.53; 95% CI, 1.05-2.23) were highly associated with bacterial gastroenteritis. The area under the receiver operating characteristic curve of the final model was 0.68 (95% CI, 0.55-0.63).
  
  
  CONCLUSIONS
  Acute bacterial gastroenteritis was highly associated with season, frequency of diarrhea, frequency of vomiting, and eating shrimp or crab.
authors.affiliation: Emergency Department, Taipei City Hospital, Ren-Ai Branch.
authors.forename: Chao-Chih
authors.initials: CC
authors.lastname: Lai
authors.forename: Dar-Der
authors.initials: DD
authors.lastname: Ji
authors.forename: Fang-Tzy
authors.initials: FT
authors.lastname: Wu
authors.forename: Jung-Jung
authors.initials: JJ
authors.lastname: Mu
authors.forename: Ji-Rong
authors.initials: JR
authors.lastname: Yang
authors.forename: Donald Dah-Shyong
authors.initials: DD
authors.lastname: Jiang
authors.forename: Wen-Yun
authors.initials: WY
authors.lastname: Lin
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.forename: Muh-Yong
authors.initials: MY
authors.lastname: Yen
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Wu
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult