Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016-2018.
Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016-2018.
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DOI：
10.1093/cid/ciaa806
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发表时间：
2021-11-02
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成人急性胃肠炎 (AGE) 的负担、病因和严重程度尚不明确。我们在 4 个退伍军人事务部医疗中心（佐治亚州亚特兰大、纽约州布朗克斯、德克萨斯州休斯顿和加利福尼亚州洛杉矶）实施了多站点 AGE 监测平台，每年总共为超过 320 000 名患者提供服务。 2016年7月1日至2018年6月30日，我们通过对入院患者的前瞻性筛查主动识别住院AGE病例和非AGE住院对照患者，并通过提交用于临床诊断的粪便样本被动识别门诊AGE患者。我们通过多重胃肠道聚合酶链式反应小组提取医学图表并测试粪便样本中的 22 种病原体，然后对诺如病毒和轮状病毒阳性样本进行基因分型。我们确定了病原体特异性患病率、发病率和修改后的 Vesikari 严重程度评分。我们招募了 724 名 AGE 住院患者、394 名非 AGE 住院对照患者和 506 名 AGE 门诊患者。艰难梭菌和诺如病毒在住院患者（AGE 病例患者与对照组：艰难梭菌，18.8% vs 8.4%；诺如病毒，5.1% vs 1.5%；两者 P < .01）和门诊患者（诺如病毒，10.7%；艰难梭菌，10.5%）中最常见。每10万人中的发病率在门诊患者（AGE，2715；艰难梭菌，285；诺如病毒，291）和≥65岁住院患者（AGE，459；艰难梭菌，91；诺如病毒，26）中最高。诺如病毒、轮状病毒和志贺氏菌/肠侵袭性大肠杆菌病例的临床严重程度评分最高。总体而言，12% 的 AGE 住院患者入住重症监护室，2% 死亡； 3 例死亡与艰难梭菌相关，1 例与诺如病毒相关。艰难梭菌和诺如病毒全年均可检测到，且以秋季/冬季为主。艰难梭菌和诺如病毒是门诊和住院美国退伍军人中的主要 AGE 病原体，导致严重疾病。临床医生应全年对 AGE 的细菌和病毒原因保持警惕。
Acute gastroenteritis (AGE) burden, etiology, and severity in adults is not well characterized. We implemented a multisite AGE surveillance platform in 4 Veterans Affairs Medical Centers (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California), collectively serving >320 000 patients annually. From 1 July 2016 to 30 June 2018, we actively identified inpatient AGE case patients and non-AGE inpatient controls through prospective screening of admitted patients and passively identified outpatients with AGE through stool samples submitted for clinical diagnostics. We abstracted medical charts and tested stool samples for 22 pathogens by means of multiplex gastrointestinal polymerase chain reaction panel followed by genotyping of norovirus- and rotavirus-positive samples. We determined pathogen-specific prevalence, incidence, and modified Vesikari severity scores. We enrolled 724 inpatients with AGE, 394 non-AGE inpatient controls, and 506 outpatients with AGE. Clostridioides difficile and norovirus were most frequently detected among inpatients (for AGE case patients vs controls: C. difficile, 18.8% vs 8.4%; norovirus, 5.1% vs 1.5%; P < .01 for both) and outpatients (norovirus, 10.7%; C. difficile, 10.5%). The incidence per 100 000 population was highest among outpatients (AGE, 2715; C. difficile, 285; norovirus, 291) and inpatients ≥65 years old (AGE, 459; C. difficile, 91; norovirus, 26). Clinical severity scores were highest for inpatient norovirus, rotavirus, and Shigella/enteroinvasive Escherichia coli cases. Overall, 12% of inpatients with AGE had intensive care unit stays, and 2% died; 3 deaths were associated with C. difficile and 1 with norovirus. C. difficile and norovirus were detected year-round with a fall/winter predominance. C. difficile and norovirus were leading AGE pathogens in outpatient and hospitalized US veterans, resulting in severe disease. Clinicians should remain vigilant for bacterial and viral causes of AGE year-round.
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