Research article

Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study

Andreas Jansen¹ , Klaus Stark¹ , Jan Kunkel² , Eckart Schreier³ , Ralf Ignatius⁴ , Oliver Liesenfeld⁴ , Dirk Werber¹ , Ulf B Göbel⁴ , Martin Zeitz² and Thomas Schneider²

¹Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

²Medical Clinic I, Campus Benjamin Franklin, Charité, Berlin, Germany

³Department for Molecular Epidemiology of Viral Pathogens, Robert Koch Institute, Berlin, Germany

⁴Department of Microbiology and Hygiene, Charité, Berlin, Germany

author email corresponding author email

BMC Infectious Diseases 2008, 8:143doi:10.1186/1471-2334-8-143

Published:	22 October 2008

Abstract

Background

The aetiology of severe gastroenteritis leading to hospitalisation in adults frequently remains unclear. Our objective was to study the causes and characteristics of community-acquired, acute gastroenteritis in adult hospitalized patients to support the clinical management of these patients.

Methods

From August 2005 to August 2007, we conducted a prospective cohort study among patients ≥18 y hospitalized with community-acquired gastroenteritis in a university hospital in Berlin, Germany. Stool specimens were examined for 26 gastrointestinal pathogens, supplemented by serologic tests for antibodies to Campylobacter spp., Yersinia spp., and Entamoeba histolytica. Patient data on demographics and clinical presentation were recorded and analyzed. Coexisting medical conditions were assessed using the Charlson Comorbidity Index score.

Results

Of 132 patients presenting with acute community-acquired gastroenteritis, 104 were included in the study. A non-infectious aetiology was diagnosed in 8 patients (8%). In 79 (82%) of the remaining 96 patients at least one microorganism was identified. Campylobacter spp. (35%) was detected most frequently, followed by norovirus (23%), Salmonella spp. (20%), and rotavirus (15%). In 46% of the patients with Campylobacter spp. infection, the diagnosis was made solely by serology. More than one pathogen was found in seventeen (22%) patients. Simultaneous infection was significantly more likely in patients with rotavirus and salmonella infections (RR 3.6; 95% CI: 1.8–7.4; RR 2.5; 95%CI: 1.2–5.5). Length of hospital stay (median: 5.5 days) was independent of the pathogen, but was associated with coexisting medical conditions (OR 4,8; 95%CI:2,0–11,6).

Conclusion

Known enteric pathogens were detected in 82% of adult patients who were hospitalized with acute gastroenteritis. We found that currently used culture-based methods may miss a substantial proportion of Campylobacter infections, and additional serological testing for Campylobacter should be considered. Viral infections emerged as an important cause of severe gastroenteritis in adults, and viral-bacterial co-infections in adults are probably underrecognized so far. The presence of coexisting medical conditions – but not the etiological agent – was a predictor for the duration of the hospital stay.