Upon completion of the chapter, the reader will be able to:
Describe the epidemiology and clinical presentation of commonly encountered GI infections.
Summarize common risk factors associated with the development of a GI infection.
Given a patient with a GI infection, develop an individualized treatment plan.
Outline the impact of widespread antimicrobial resistance on current treatment recommendations for GI infections.
Discuss the effect of host immunosuppression on the risk of disease complications and treatment strategies associated with GI infections.
Educate patients on appropriate prevention measures of GI infections.
Describe the role of antimicrobial prophylaxis and/or vaccination for GI infections.
Rehydration is the foundation of therapy for GI infections.
The indiscriminate use of proton-pump inhibitor (PPI) therapy leads to GI-tract bacterial colonization and increased susceptibility to enteric bacterial infections.
Blood in the stool indicates the possibility of inflammatory mucosal disease of the colon such as enterohemorrhagic Escherichia coli (EHEC), which is an important cause of bloody diarrhea in the United States.
Traveler's diarrhea is most commonly caused by bacteria such as Shigella, Salmonella, Campylobacter, and enterotoxigenic E. coli (ETEC), although viruses are increasingly recognized as a significant cause of traveler's diarrhea as well.
The education of travelers about high-risk food and beverages is an important component in the prevention of traveler's diarrhea.
Nosocomial Clostridium difficile–associated diarrhea (CDAD) is almost always associated with antimicrobial use; therefore, unnecessary and inappropriate antibiotic therapy should be avoided. Almost all antibiotics except aminoglycosides have been associated with CDAD.
Viruses are the most common cause of diarrheal illness in the world. A live, oral vaccine is licensed and recommended for use in infants for the prevention of rotavirus infection.
One of the primary concerns related to GI infection, regardless of the cause, is dehydration, which is the second leading cause of worldwide morbidity and mortality.1 Worldwide, dehydration is especially problematic for children younger than age 5. However, the highest rate of death in the United States occurs among the elderly.1 Rehydration is the foundation of therapy for GI infections, and oral rehydration therapy (ORT) is usually preferred (Table 76–1).
Table 76–1Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss |Favorite Table|Download (.pdf) Table 76–1 Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss
|Variable ||Mild (3–5%) ||Moderate (6–9%) ||Severe (10% or More) |
|Blood pressure ||Normal ||Normal ||Normal to reduced |
|Quality of pulses ||Normal ||Normal to slightly decreased ||Moderately decreased |
|Heart rate ||Normal ||Increased ||Increased (bradycardia in severe cases) |
|Skin turgor ||Normal ||Decreased ||Decreased |
|Fontanelle ||Normal ||Sunken ||Sunken |
|Mucous membranes ||Slightly dry ||Dry ||Dry |
|Eyes ||Normal ||Sunken orbits/decreased tears ||Deeply sunken orbits/decreased tears |
|Extremities ||Warm, normal capillary refill ||Delayed capillary refill ||Cool, mottled |
|Mental status ||Normal ||Normal to listless ||Normal ...|
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