Bacterial diarrhea: a prospective study in Primary Care

Objective: To know the epidemiological characteristics of bacterial diarrhea in our setting. Method: Prospective study of bacterial diarrhea diagnosed from May 1st 1993 until April 30th 1998 in children adscribed to Health Care Centres of Segorbe and Soneja in Castellón (Spain). Request of a control stool culture every two weeks until three negatives were obtained. Results: Of a total of 829 patients, 66 (8.0%) were diagnosed of bacterial diarrhea. No statistical significance concerning sex was found. Age when first episode was 26.4 ± 26.5 months (mean ± SD), moda at 14 months (7.8%). 66 patients had up to 77 diarrhoea episodes. In 75,3% at least three negative stool cultures were obtained. In 7,8% there was one positive after two negative ones. Microbiologic results (n = 77): Campylobacter 61.0%, Salmonella 31.2%, Yersinia 3.9%, Shigella 2.6%, Aeromonas 1.3%. The most frequent signs were fever 46.8%, with mucus 42,9%, stools with blood 36.4% and vomiting 31.2%. No statistical significance in clinical symptoms between microorganisms was found. Seven patients were hospitalised, two of them with reactive arthritis by Campylobacter. 30 episodes were treated with antibiotics: twenty Campylobacter (nine with erythromycin, nine with clarithromycin), nine Salmonella (five with trimethoprim-sulfamethoxazole) and one Shigella (trimethoprim-sulfamethoxazole). 65.9% of the Salmonella strains were sensitive to trimethoprim-sulfamethoxazole, 96.6% of Campylobacter to erythromycin and 100% of Shigella to trimethoprim-sulfamethoxazole. Conclusions: Campylobacter seems to be the most frequent agent. Clinical symptoms do not allow to predict the causing microorganism. 39% of total episodes were treated with antibiotics. Some strains were found resistant to antibiotics.