IDSA updates infectious diarrhea guidelines for first time since 2001
For the first time since 2001, the Infectious Diseases Society of America has updated its practice guidelines for the diagnosis and management of infectious diarrhea.
The new guidelines, published today in Clinical Infectious Diseases, include seven tables that clinicians can reference for information about how patients become infected, their symptoms, clinical presentations and appropriate therapies, including recommended antimicrobial, fluid and nutritional management.
According to the guidelines, each year, acute gastroenteritis is responsible for 179 million outpatient visits, nearly 500,000 hospitalizations and more than 5,000 deaths in the United States. Most diarrheal illnesses are self-limiting, and most patients with diarrhea do not need to be tested, according to the guidelines. Those who should be tested include patients younger than age 5 years, the elderly, patients who are immunocompromised and those who have bloody diarrhea, severe abdominal pain or tenderness or signs of sepsis, the IDSA said.
Over the past several years, more physicians have relied on culture-independent diagnostic tests (CIDTs) to detect enteric infections in their patients. CIDTs are more sensitive and can provide quicker results than traditional methods, leading to faster diagnoses. But there are drawbacks to their use, including the loss of important data on pathogen subtypes and antimicrobial resistance, which make it more difficult to monitor trends or link infections to outbreaks.
“Diagnostic testing combined with clinical expertise is helpful in identifying a cluster of infections that may signal an outbreak,” Andi L. Shane, MD, MPH, MSc, lead author of the guidelines and associate professor of pediatric infectious diseases at Emory University School of Medicine, said in an IDSA news release. “However, even if they don’t need to be tested, most people will benefit from rehydration therapy while waiting for the infection to run its course.”
According to the IDSA, infectious disease expertise may be necessary to interpret the clinical significance of CIDT results and facilitate appropriate public health surveillance. Consultation with an infectious disease expert may also benefit physicians who do not recognize organisms detected by a CIDT.
“We need the frontline clinicians to be astute and notice if they are seeing patients with an unusual infection, or a number of similar infections from a specific location such as a child care center, nursing home or eating facility and then work closely with the state and local health authorities,” Larry Pickering, MD, co-author of the guidelines and adjunct professor of pediatrics at Emory University School of Medicine, said in the news release. “This is the optimal way to develop community awareness and use an integrated approach to identify and contain an outbreak.”
In an accompanying editorial, Ferric C. Fang, MD, professor of laboratory medicine and microbiology at the University of Washington School of Medicine, and Robin Patel, MD, director of the infectious diseases research laboratory at the Mayo Clinic, called the new IDSA guidelines a “welcome update.”
Fang and Patel, who are also Clinical Infectious Diseases editors, highlighted several aspects of the new guidelines from a clinical microbiology perspective, including noting the impact of CIDTs, which they called “a game-changer.”
“A specific diagnosis can provide information regarding the likely course of illness, which can be important for patient satisfaction and life planning, as well as guide management in special circumstances, such as when diarrhea occurs in food workers or children in day care,” they wrote. “Moreover, a specific diagnosis can facilitate public health surveillance efforts; authors of the earlier guideline expressed hope that the development of rapid diagnostic tests would eventually improve the diagnosis, management and prevention of infectious diarrhea. ... The hope expressed in 2001 has become a reality in 2017.” – by Gerard Gallagher
Disclosures: Please see the guidelines and editorial for all authors’ relevant financial disclosures.