Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016-2018

• Type of Material: Article
• Authors: Cristina Cardemil, Emory University; Neha Balachandran, Cherokee Nation Assurance; Anita Kambhampati, Cherokee Nation Assurance; Scott Grytdal, Centers for Disease Control and Prevention, Atlanta; Rebecca M Dahl, Maximus Fed; Maria C Rodriguez-Barradas, Baylor College of Medicine; Blanca Vargas, Baylor College of Medicine; David O Beenhouwer, VA Greater Los Angeles Healthcare System; Karen Evangelista, VA Greater Los Angeles Healthcare System; Vincent Marconi, Emory University; Kathryn L Meagley, Atlanta VA Medical Center; Sheldon T Brown, James J. Peters VA Medical Center; Adrienne Perea, James J. Peters VA Medical Center; Cynthia Lucero-Obusan, US Department of Veterans Affairs; Mark Holodniy, US Department of Veterans Affairs; Hannah Browne, Cherokee Nation Assurance, Arlington; Rashi Gautam, Centers for Disease Control and Prevention, Atlanta; Michael D Bowen, Centers for Disease Control and Prevention, Atlanta; Jan Vinje, Centers for Disease Control and Prevention, Atlanta; Umesh D Parashar, Centers for Disease Control and Prevention, Atlanta; Aron J Hall, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2021-11-02
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Published by Oxford University Press for the Infectious Diseases Society of America 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciaa806
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Volume: 73
• Issue: 9
• Start Page: E2729
• End Page: E2738
• Grant/Funding Information: This study was funded by the Centers for Disease Control and Prevention and by the Emory Center for AIDS Research (funding for laboratory personnel at the Atlanta VAMC).
• Keywords: Infectious Diseases; Life Sciences & Biomedicine; CLOSTRIDIUM-DIFFICILE INFECTION; Science & Technology; Immunology; Microbiology; NOROVIRUS; DISEASES; OUTBREAKS; TRENDS; BURDEN; ADULTS; EPIDEMIOLOGY; UNITED-STATES

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.