Gastroenteritis

• Stool specimens in patients hospitalized for > 3 days should not be submitted for stool diagnostic studies unless patient admitted with diarrhea or there is nosocomial outbreak of diarrhea. Diarrhea in hospitalized children (≥ 1 year old) warrants investigation for Clostridioides (Clostridium) difficile.

• Recommend blood culture if febrile and systemically unwell.

• Causes of bloody diarrhea:

  • Campylobacter spp

  • Shigella spp

  • Nontyphoidal Salmonella spp

  • Shiga toxin-producing E. coli, including E. coli O157:H7

  • Aeromonas spp

  • Vibrio spp, not V. cholerae

  • Yersinia spp

  • E. histolytica

  • C. difficile

• Severe bloody diarrhea in afebrile patients should increase suspicion of E. coli O157:H7. Most common in children < 5 years old.

• Avoid antimotility agents in children < 2 years old, or in children of any age if fever present and/or if blood in stool.