2016-2018 年 4 家退伍军人事务部医院和门诊中心前瞻性纳入患者的急性胃肠炎发病率、病因和严重程度。
Incidence, Etiology, and Severity of Acute Gastroenteritis Among Prospectively Enrolled Patients in 4 Veterans Affairs Hospitals and Outpatient Centers, 2016-2018.
机构信息
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Cherokee Nation Assurance, Arlington, Virginia, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA.
出版信息
Clin Infect Dis. 2021 Nov 2;73(9):e2729-e2738. doi: 10.1093/cid/ciaa806.
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.
背景
成人急性肠胃炎（AGE）的负担、病因和严重程度尚未得到充分描述。我们在 4 家退伍军人事务医疗中心（佐治亚州亚特兰大、纽约州布朗克斯、德克萨斯州休斯顿和加利福尼亚州洛杉矶）建立了一个多地点 AGE 监测平台，每年为超过 32 万名患者提供服务。
方法
从 2016 年 7 月 1 日至 2018 年 6 月 30 日，我们通过对住院患者的前瞻性筛查主动识别住院 AGE 病例患者和非 AGE 住院对照患者，通过提交用于临床诊断的粪便样本被动识别门诊 AGE 患者。我们通过多重胃肠聚合酶链反应面板提取病历并检测 22 种病原体，并对诺如病毒和轮状病毒阳性样本进行基因分型。我们确定了病原体特异性的患病率、发病率和改良 Vesikari 严重程度评分。
结果
我们纳入了 724 名住院 AGE 患者、394 名非 AGE 住院对照患者和 506 名门诊 AGE 患者。艰难梭菌和诺如病毒在住院患者中最常被检测到（对于 AGE 病例患者与对照患者：艰难梭菌，18.8%比 8.4%；诺如病毒，5.1%比 1.5%；均<.01），在门诊患者中也是如此（诺如病毒，10.7%；艰难梭菌，10.5%）。每 100000 人口的发病率在门诊患者中最高（AGE，2715；艰难梭菌，285；诺如病毒，291），在≥65 岁的住院患者中也很高（AGE，459；艰难梭菌，91；诺如病毒，26）。住院诺如病毒、轮状病毒和志贺菌/侵袭性大肠杆菌病例的临床严重程度评分最高。总的来说，12%的 AGE 住院患者需要入住重症监护病房，2%的患者死亡；3 例死亡与艰难梭菌有关，1 例与诺如病毒有关。艰难梭菌和诺如病毒全年都有检测到，以秋季/冬季为主。
结论
艰难梭菌和诺如病毒是美国退伍军人门诊和住院患者中主要的 AGE 病原体，导致严重疾病。临床医生应全年保持警惕，注意细菌性和病毒性 AGE 的病因。
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