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Skyum F, Pedersen C, Andersen V, Chen M, Franke A, Petersen D, Ries W, Mogensen CB. Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - a prospective observational multicentre study. BMC Infect Dis 2019; 19:133. [PMID: 30744568 PMCID: PMC6371479 DOI: 10.1186/s12879-019-3754-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
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 ¼ 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).
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Affiliation(s)
- Florence Skyum
- Focused Research Unit in Emergency Medicine, Hospital of Southern Denmark, Kresten Philipsens Vej 15, DK-6200, Aabenraa, Denmark. .,Institute for Regional Health Research, University of Southern Denmark, JB Winsløw Vej 25, DK-5000, Odense, Denmark. .,Focused Research Unit in Emergency Medicine, Hospital of Southern Jutland, Kresten Philipsens Vej 15, DK-6200, Aabenraa, Denmark.
| | - Court Pedersen
- Department of Infectious Disease, Odense University Hospital, JB Winsløws vej 4, DK-5000, Odense, Denmark
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Hospital of Southern Jutland, Kresten Philipsens Vej 15, DK-6200, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, JB Winsløw vej 25, DK-5000, Odense, Denmark
| | - Ming Chen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, Hospital of Southern Jutland, Kresten Philipsens Vej 15, DK-6200, Aabenraa, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, DK, Denmark
| | - Andreas Franke
- Department of Medicine II, Malteser Krankenhaus St. Franziskus-Hospital, Waldstraße 17, 24939, Flensburg, Germany
| | - Detlev Petersen
- Department of Laboratory- and Transfusionmedicine, Ev.Luth. Diakonissenanstalt zu Flensburg, Knuthstr.1, 24939, Flensburg, Germany
| | - Wolfgang Ries
- Department of Medicine, Ev.Luth. Diakonissenanstalt zu Flensburg, Knuthstr.1, 24939, Flensburg, Germany
| | - Christian Backer Mogensen
- Focused Research Unit in Emergency Medicine, Hospital of Southern Denmark, Kresten Philipsens Vej 15, DK-6200, Aabenraa, Denmark.,Institute for Regional Health Research, University of Southern Denmark, JB Winsløw Vej 25, DK-5000, Odense, Denmark
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Infectious gastroenteritis and the need for strict contact precaution procedures in adults presenting to the emergency department: a Danish register-based study. J Hosp Infect 2017; 98:391-397. [PMID: 29128345 DOI: 10.1016/j.jhin.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acute infectious gastroenteritis requires contact precautions to prevent spread. On acute admission, the cause of diarrhoea is unknown, so the decision regarding which patients to isolate has to be made on clinical information with a risk of inexpedient use of contact precautions. AIM To investigate how often gastroenteritis occurs (and therefore how often the need for isolation has to be assessed) in Danish emergency departments, and how often patients have to remain on contact precautions according to the results of faecal samples. METHODS This Danish register-based retrospective cohort study on adults in Danish emergency departments used three data sources: discharge diagnoses from the Danish National Patient Register; microbiological results from faecal samples provided in the emergency department; and the causes of hospital admission based on the chief complaint. FINDINGS Among 66,885 acute admissions, 4.3% of patients had at least one feature of gastroenteritis: admission with diarrhoea as the chief complaint (1.6%); microbiological examination of faecal sample (2.8%); and discharged with a diagnosis of gastroenteritis (1.7%). Nineteen percent of those who had a faecal sample tested were found to have norovirus or Clostridium difficile, and needed to remain on strict contact precautions. CONCLUSION The initiation of contact precautions has to be assessed for 4.3% of all emergency department patients; 19% of the patients who had a faecal sample tested had highly contagious gastroenteritis and required strict contact precautions. Further studies are needed to develop tools to determine which patients to isolate.
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