TY - JOUR
T1 - Relationship between enteric pathogens and acute gastroenteritis disease severity
T2 - a prospective cohort study
AU - Pediatric Emergency Research Canada (PERC) and the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE Team)
AU - Xie, J.
AU - Nettel-Aguirre, A.
AU - Lee, B. E.
AU - Chui, L.
AU - Pang, X. L.
AU - Zhuo, R.
AU - Parsons, B.
AU - Vanderkooi, O. G.
AU - Tarr, P. I.
AU - Ali, S.
AU - Dickinson, J. A.
AU - Hagen, E.
AU - Svenson, L. W.
AU - MacDonald, S. E.
AU - Drews, S. J.
AU - Tellier, R.
AU - Graham, T.
AU - Lavoie, M.
AU - MacDonald, J.
AU - Freedman, S. B.
N1 - Funding Information:
The authors have no conflicts of interest relevant to this article to disclose. This work was supported by the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE), which is funded by a grant from the Alberta Innovates–Health Solutions Team Collaborative Innovation Opportunity (Award #: 201300680 ). APPETITE is also supported by the Alberta Children's Hospital Research Institute (Calgary, Alberta) and the Women and Children's Health Research Institute (Edmonton, Alberta), through a Partnership Award. S.F. is supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness . The Pediatric Emergency Medicine Research Associate Program (PEMRAP) is supported by a grant from the Alberta Children's Hospital Foundation . In-kind support to enable the conduct of this study is provided by Calgary Laboratory Services, Provincial Laboratory for Public Health in Alberta, Luminex Corporation, and Copan Italia. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The researchers are independent from the funders, and all authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Information:
The authors have no conflicts of interest relevant to this article to disclose. This work was supported by the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE), which is funded by a grant from the Alberta Innovates?Health Solutions Team Collaborative Innovation Opportunity (Award #: 201300680). APPETITE is also supported by the Alberta Children's Hospital Research Institute (Calgary, Alberta) and the Women and Children's Health Research Institute (Edmonton, Alberta), through a Partnership Award. S.F. is supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness. The Pediatric Emergency Medicine Research Associate Program (PEMRAP) is supported by a grant from the Alberta Children's Hospital Foundation. In-kind support to enable the conduct of this study is provided by Calgary Laboratory Services, Provincial Laboratory for Public Health in Alberta, Luminex Corporation, and Copan Italia. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The researchers are independent from the funders, and all authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. We would like to thank the following: Ms Bryanne Crago, Christina Ferrato from Provincial Laboratory for Public Health, and Dr Judy Qiu from the Department of Laboratory Medicine and Pathology, University of Alberta, the staff from DynaLIFE Dx Diagnostic Laboratory Services, Calgary Laboratory Services, community laboratories as well as Provincial Laboratory for Public Health in Alberta, for their assistance with specimen receiving, handling and processing; the ED research nurses and the Pediatric Emergency Medicine Research Associate Program (PEMRAP) at the Alberta Children's Hospital for recruiting study participants; the ED bedside nurses for assisting with obtaining rectal swabs; Ms Nadia Dow and Ms Manasi Rajagopal, as well as the research assistants, research nurses, and Little Bit of Help (LBoH) research volunteer programme for their assistance with participant recruitment at the Stollery Children's Hospital; and the nurses at Health Link Alberta who respond to calls from across the province for their assistance with participant recruitment. We would like to thank Ms Laurel Ryan for her role as patient advisor. We would like to extend special thanks to Dr. Marie Louie for building the connections that have made our endeavours possible.
Publisher Copyright:
© 2018 European Society of Clinical Microbiology and Infectious Diseases
PY - 2019/4
Y1 - 2019/4
N2 - Objectives: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. Methods: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). Results: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. Conclusions: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
AB - Objectives: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. Methods: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). Results: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. Conclusions: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
KW - Adenoviridae
KW - Child
KW - Diarrhoea
KW - Gastroenteritis
KW - Hospital Emergency Service
KW - Norovirus
KW - Rotavirus
KW - Salmonella
KW - Vomiting
UR - http://www.scopus.com/inward/record.url?scp=85050509814&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2018.06.016
DO - 10.1016/j.cmi.2018.06.016
M3 - Article
C2 - 29964235
AN - SCOPUS:85050509814
SN - 1198-743X
VL - 25
SP - 454
EP - 461
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 4
ER -