Gastroenteritis

• Stool specimens in patients hospitalized for > 3 days should not be submitted for stool diagnostic studies unless patient admitted with diarrhea or nosocomial outbreak of diarrhea.

• 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. More common in children <5 years old.

• Do not use bismuth subsalicylate with quinolones as binding decreases quinolone absorption.

• Avoid antimotility agents if fever present or concern for toxic megacolon.  Antimotility agents can be given to patients receiving antibiotics for gastroenteritis to decrease duration of diarrhea and increase chance for a cure.