Bacterial gastroenteritis: Difference between revisions

Latest revision as of 21:18, 6 January 2026

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See Acute gastroenteritis (peds) for pediatric patients

Background

Most acute gastroenteritis (AGE) is viral, not bacterial
Bloody diarrhea suggests bacterial etiology
Do NOT diagnose isolated vomiting as AGE

Clinical Features and Causes

Noninvasive AGE
Species	Onset	Symptoms	Transmission	Preformed Toxin
Viral (norovirus, adenovirus, rotavirus)	11-72 hrs	Nausea, vomiting, watery diarrhea Mild abdominal cramps, myalgia	Fecal-oral Contaminated food or water	No
Staph	1-6 hrs	Nausea, severe vomiting, diarrhea, Mild abdominal cramping	Previously cooked foods (mayonaise, ham, salads)	Yes
B. cereus	1-6 hrs	Abrupt onset of nausea, vomiting, mild diarrhea	Previously cooked foods (rice, vegetables, dried fruits, meat)	Yes
C. perfringens	8-24 hrs	Nausea, minimal vomiting, watery diarrhea Abd cramps	Previously cooked or reheated meats and poultry	Yes
V. cholerae	11-72 hrs	Explosive rice-water diarrhea Vomiting, abdominal cramps Fever	Fecal-oral Contaminated food or water	No
Giardia	1-4 wks	Flatus, bloating Foul-smelling and fatty stools (steatorrhea)	Fecal-oral Contaminated water	No

Invasive AGE
Species	Onset	Symptoms	Transmission
Salmonella	6-72 hours	Fever, relative bradycardia Abdominal pain Bloody diarrhea Headache Osteomyelitis in sickle cell	Eggs Poultry Water Reptiles
Shigella	1-3 days	Fever Abdominal pain Bloody diarrhea Headache 1-5 years old Seizures in children	Food Fecal-Oral
Yersinia	1-5 days	Appendicitis mimic, RLQ pain Fever Vomiting Kids and Young Adults	Water Milk Pork Wild Animals Fecal-Oral
Campylobacter	1-7 days	Low grade fever Abdominal pain Kids and Young Adults Guillain-Barre	Water Poultry Pets/Animals
C. Diff	1-11 Weeks	Copious FOUL diarrhea	Antibiotic use: PCN, Clinda, Cephalosporins
Entamoeba	1-11 weeks	Appendicitis Mimic Abdominal pain, nausea/vomiting, diarrhea	Water Sanitation Travel

Differential Diagnosis

Diffuse Abdominal pain

Nausea and vomiting

Critical

Emergent

Acute radiation syndrome
Acute gastric dilation
Adrenal insufficiency
Appendicitis
Bowel obstruction/ileus
Carbon monoxide poisoning
Cholecystitis
CNS tumor
Electrolyte abnormalities
Elevated ICP
Gastric outlet obstruction, gastric volvulus
Hyperemesis gravidarum
Medication related
Pancreatitis
Peritonitis
Ruptured viscus
Testicular torsion/ovarian torsion

Nonemergent

Acute gastroenteritis
Biliary colic
Cannabinoid hyperemesis syndrome
Chemotherapy
Cyclic vomiting syndrome
ETOH
Gastritis
Gastroenteritis
Gastroparesis
Hepatitis
Labyrinthitis
Migraine
Medication related
- Disulfiram effect
- Erythromycin
- Ibuprofen
- Ipecac toxicity
Motion sickness
Narcotic withdrawal
Thyroid
Pregnancy
Peptic ulcer disease
Renal colic
UTI

Evaluation

Assess hydration status
- Cap refill, skin turgor, respiratory rate
Consider stool studies if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea

Management

Rehydration (PO preferred)
- 30mL(1oz)/kg/hr
- Reduced-osmolarity oral rehydration solution
Antiemetic
- Ondansetron 0.15mg/kg/dose IV/PO
Antibiotics
- Only consider in patients with invasive infection
  - Shigella, campylobacter, E. coli, yersinia, vibrio
  - Bloody stool with mucus and fever
- NOT indicated for E. coli O157:H7
- NOT routinely indicated for salmonella
  - Exceptions: SCD, IBD, <3mo
- Azithromycin (able to tolerate PO)
- OR ciprofloxacin
- OR TMP-SMX
- Ceftriaxone (parenteral)

Disposition

Most can be discharged
Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities

External Links

References

Authors:

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+<!--T:1-->
 ''See [[Special:MyLanguage/Acute gastroenteritis (peds)|Acute gastroenteritis (peds)]] for pediatric patients''
-==Background==
+==Background== <!--T:2-->
+<!--T:3-->
 *Most acute gastroenteritis (AGE) is viral, not bacterial
 *[[Special:MyLanguage/rectal bleeding|Bloody diarrhea]] suggests bacterial etiology
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+===Clinical Features and Causes=== <!--T:4-->
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-==Evaluation==
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 *Assess hydration status
 **Cap refill, skin turgor, respiratory rate
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 #[[Special:MyLanguage/oral rehydration therapy|Rehydration]] (PO preferred)
 #*30mL(1oz)/kg/hr
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 *Most can be discharged
 *Admit
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 *[[Special:MyLanguage/Acute gastroenteritis|Acute gastroenteritis]]
 *[[Special:MyLanguage/Nausea and Vomiting|Nausea and Vomiting]]
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-==External Links==
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 <references/>
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 [[Category:ID]] [[Category:GI]]
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