1190. Relationship between Enteropathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study
Session: Poster Abstract Session: Enteric Infections and Diagnostics
Friday, October 6, 2017
Room: Poster Hall CD
  • ID week poster Relationship Between Enteric Pathogen and Acute Gastroenteritis Disease Severity A Prospective Cohort Study.pdf (552.5 kB)
  • Background: 

    Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. 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.


    We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11 - 20 points) vs. non-severe (0 - 10 points).


    The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease.


    In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII.

    Stephen Freedman, MDCM, MSc1, Jianling Xie, MD, MPH2, Alberto Nettel-Aguirre, PhD, PStat3, Bonita Lee, MD MSc (Epi)4, Linda Chui, MD5, Xiao-Li Pang, PhD5, Ran Zhuo, PhD5, Brendon Parsons, PhD6, Otto G. Vanderkooi, MD7, Phillip Tarr, MD, FIDSA8, Samina Ali, MDCM5, James A. Dickinson, MBBS, PhD9, Evan Hagen, B.Sc.10, Lawrence W Svenson, PhD11, Shannon E. MacDonald, PhD, RN12, Steven J. Drews, PhD13, Raymond Tellier, MD, MSc14, Tim Graham, MD, MSc5, Martin Lavoie, MD15, Judy Macdonald, MD16 and Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE), (1)Pediatrics, University of Calgary, Calgary, AB, Canada, (2)Alberta Children's Hospital, University of Calgary, Clagary, AB, Canada, (3)Alberta Children’s Hospital Research Institute, O’Brien Population Health Institute, University of Calgary, Calgary, AB, Canada, (4)Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada, (5)University of Alberta, Edmonton, AB, Canada, (6)Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada, (7)The University of Calgary, Calgary, AB, Canada, (8)Washington University School of Medicine, St. Louis, MO, (9)Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada, (10)Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada, (11)Analytics and Performance Reporting Branch, Government of Alberta Ministry of Health, Edmonton, AB, Canada, (12)Faculty of Nursing, University of Alberta, Edmonton, AB, Canada, (13)Provincial Laboratory for Public Health, Edmonton, AB, Canada, (14)University of Calgary, Calgary, AB, Canada, (15)Government of Alberta, Edmonton, AB, Canada, (16)Public Health, Alberta Health Services, Calgary, AB, Canada


    S. Freedman, None

    J. Xie, None

    A. Nettel-Aguirre, None

    B. Lee, None

    L. Chui, None

    X. L. Pang, None

    R. Zhuo, None

    B. Parsons, None

    O. G. Vanderkooi, None

    P. Tarr, None

    S. Ali, None

    J. A. Dickinson, None

    E. Hagen, None

    L. W. Svenson, None

    S. E. MacDonald, None

    S. J. Drews, None

    R. Tellier, None

    T. Graham, None

    M. Lavoie, None

    J. Macdonald, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.