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David A. Talan, Gregory J. Moran, Michael Newdow, Samuel Ong, William R. Mower, Janet Y. Nakase, Robert W. Pinner, Laurence Slutsker, Etiology of Bloody Diarrhea among Patients Presenting to United States Emergency Departments: Prevalence of Escherichia coli O157:H7 and Other Enteropathogens, Clinical Infectious Diseases, Volume 32, Issue 4, 15 February 2001, Pages 573–580, https://doi.org/10.1086/318718
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Abstract
Escherichia coli O157:H7 and other Shiga toxin—producing E. coli (STEC) infections have been associated with bloody diarrhea. The prevalence of enteropathogens among patients with bloody diarrhea was determined by a prospective study at 11 US emergency departments. Eligible patients had bloody stools, ⩾3 loose stool samples per 24-h period, and an illness lasting <7 days. Among 873 patients with 877 episodes of bloody diarrhea, stool samples for culture were obtained in 549 episodes (62.6%). Stool cultures were more frequently ordered for patients with fever, >10 stools/day, and visibly bloody stools than for patients without these findings. Enteropathogens were identified in 168 episodes (30.6%): Shigella (15.3%), Campylobacter (6.2%), Salmonella (5.8%), STEC (2.6%), and other (1.6%). Enteropathogens were isolated during 12.5% of episodes that physicians thought were due to a noninfectious cause. The prevalence of STEC infection varied by site from 0% to 6.2%. Hospital admissions resulted from 195 episodes (23.4%). These data support recommendations that stool samples be cultured for patients with acute bloody diarrhea.