Background: Acute gastroenteritis is one of the top reasons children are brought for emergency department care. Little is known about the association between specific pathogens and disease severity in children with vomiting/diarrhea in the outpatient setting. Recent advances in diagnostic approaches enabling the simultaneous detection of common pathogenic enteric bacteria, viruses, and parasites have become readily available. Clinicians can request testing be performed to rapidly and comprehensively identify etiologic pathogens. While such knowledge can be used to optimize therapy, it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy. Objective: To evaluate the relationship between individual enteric pathogens and disease severity in outpatient children with acute gastroenteritis. Methods: We conducted a prospective cohort study of children with acute gastroenteritis who were brought for ED care. The outcome for this study was the Modified Vesikari Scale (MVS) score. Clinical data and outcomes were collected to quantify disease severity from symptom onset until the day-14 follow-up (total MVS score). The MVS scores were categorized as severe (i.e. ≥ 11 points on the MVS score) vs. non-severe (i.e. < 11 points on the MVS score). Stool and/or rectal swab specimens were collected and analyzed for 28 unique pathogens by molecular diagnostic assays and/or culture. A patient was classified as positive for an enteric pathogen if any specimen tested positive with any methods of test. We performed logistic regression analysis to assess the association between pathogens and disease severity with the dependent variable being the total MVS score (severe vs. non-severe) adjusted for age, presence of chronic disease, antibiotic use in the preceding 60 days and the duration of acute gastroenteritis symptoms at the time of ED presentation. Results: Between December 2014 and August 2016, we enrolled 1102 participants of whom MVS scores and specimen combinations were available for the study. The mean total MVS score was 12.8 ± 3.2. 73.0% (807/1102) of participants had severe disease during the illness. A pathogen was identified in 72.8% (802/1102) of study participants; 584 (53.0%) children had one pathogen identified, and 218 (19.8%) had ≥ 2 two pathogens identified. Rotavirus, Norovirus G2 and Adenovirus were identified in 26.6%, 23.0% and 16.0% of participants respectively. Significant predictors of severe disease were: rotavirus OR=8.0 (4.8, 13.2), Salmonella OR=5.4 (1.2, 24.4), adenovirus OR=2.1 (1.3, 3.3), norovirus G2 OR=1.8 (1.3, 2.6) and age (month) OR=0.99 (0.99, 0.99). Clostridium difficile and Aeromonas were not found to have association with severe disease. Conclusion: We found children with acute gastroenteritis in Alberta, Canada, the most common enteric pathogens included rotavirus, norovirus G2 and adenovirus that were found to have strong association with severe disease.
Relationship between Enteric Pathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study
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Jianling Xie, Stephen Freedman, Alberto Nettel-Aguirre, Bonita Lee; Relationship between Enteric Pathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study. Pediatrics May 2018; 142 (1_MeetingAbstract): 126. 10.1542/peds.142.1MA2.126
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