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Chapter 76: Gastrointestinal Infections

Bradley W. Shinn; Sharon Ternullo

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Content Update

December 29, 2019

2019 CDC Antibiotic-Resistance Threats Report: In November 2019 the U.S. Centers for Disease Control and Prevention (CDC) released an updated report on antibiotic resistance threats, last published in 2013. The report includes the latest national infection and death estimates, including 2.8 million antibiotic-resistant infections occurring in the U.S. each year and over 35,000 deaths. The report also notes 223,900 cases of Clostridiodes difficile in 2017 with at least 12,800 deaths. The report provides data on 18 antibiotic-resistant bacteria and fungi in three categories based on level of concern to human health – urgent, serious, and concerning. The report serves as a reference for information on antibiotic resistance and provides the latest estimates on antibiotic resistance burden.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the epidemiology and clinical presentation of commonly encountered gastrointestinal (GI) infections.

  2. Summarize common risk factors associated with the development of a GI infection.

  3. Given a patient with a GI infection, develop an individualized treatment plan.

  4. Outline the impact of widespread antimicrobial resistance on current treatment recommendations for GI infections.

  5. Discuss the effect of host immunosuppression on the risk of disease complications and treatment strategies associated with GI infections.

  6. Educate patients on appropriate prevention measures of GI infections.

  7. Describe the role of antimicrobial prophylaxis and/or vaccination for GI infections.

INTRODUCTION

One of the primary concerns related to gastrointestinal (GI) infection, regardless of the cause, is dehydration, which is the second leading cause of worldwide morbidity and mortality.1 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 image Rehydration is the foundation of therapy for GI infections, and oral rehydration therapy (ORT) is usually preferred (Table 76–1).2 Single-dose oral ondansetron should be considered the first-line antiemetic in children who are dehydrated with significant vomiting.3 In nonimmunocompromised hospitalized pediatric patients, Lactobacillus supplementation may reduce the length of hospitalization.4

Table 76–1Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss
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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 to lethargic to comatose
Urine output Slightly decreased < ...

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