Guidance

Text description of 5.1.4 Gastroenteritis in hospital (in-patients) setting algorithm

Updated 28 October 2020

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This publication is available at https://www.gov.uk/government/publications/smi-s-7-gastroenteritis-and-diarrhoea/text-description-of-514-gastroenteritis-in-hospital-in-patients-setting-algorithm

This page provides an accessible text description of algorithm ‘5.1.4 Gastroenteritis in the hospital (in-patients) setting’ from the UK Standards for Microbiology Investigations document ‘S 7: Gastroenteritis’. For the full document please see the S 7: Gastroenteritis download page.

This algorithm describes the suggested primary and secondary microbiological testing to undertake in patients presenting with gastroenteritis in the hospital setting.

1. Sporadic cases (less than 72 hours since hospital admission)

In the case of a patient presenting with acute diarrhoea primary testing includes the following organisms as a routine screen:

  • Salmonella
  • Shigella
  • Campylobacter
  • STEC (including O157)
  • Norovirus
  • Giardia spp.
  • Cryptosporidium spp.

C. difficile may also be considered under primary testing. Refer to B 10 for further information.

1.1 Additional investigations following clinical details

If travel specific information is provided eg countries/areas indicated primary testing includes the following organisms:

  • OCP
  • Vibrio spp.

If shellfish is indicated primary testing includes the following organisms:

  • Vibrio spp.
  • OCP

If mesenteric adenitis is indicated primary testing includes the following organism:

  • Yersinia

If the patient is immunocompromised primary testing includes the following organisms:

  • OCP

If the patient is immunocompromised secondary testing includes the following organisms:

  • Sapovirus
  • Astrovirus

2. Sporadic cases (more than 72 hours since hospital admission)

2.1 Immunocompetent

In the case of an immunocompetent patient presenting with acute or persistent diarrhoea primary testing includes the following organisms:

  • OCP
  • Giardia spp.
  • Cryptosporidium spp.
  • C. difficile (refer to B 10)
  • Norovirus

2.2 Immunocompromised

In the case of an immunocompromised patient presenting with acute or persistent diarrhoea primary testing includes the following organisms:

  • C. difficile (refer to B 10)
  • Norovirus
  • Rotavirus
  • Adenovirus
  • OCP
  • Giardia spp.
  • Cryptosporidium spp.
  • Cyclospora sp.

3. Outbreak cases

3.1 Acute diarrhoea

In the case of an outbreak of acute diarrhoea primary testing includes the following organisms as a routine screen:

  • Salmonella
  • Shigella
  • Campylobacter
  • STEC (including O157)
  • Norovirus
  • Cryptosporidium spp.
  • Giardia spp. C. difficile may be included in primary testing (refer to B 10).

Secondary testing should include the following organisms:

  • OCP including Cyclospora sp.

If patients are immunocompromised, primary testing includes the following organisms:

  • OCP
  • Vibrio spp.

If healthcare/institution acquired, primary testing includes the following organisms:

  • C. difficile (refer to B 10)
  • Norovirus
  • Rotavirus
  • Adenovirus

If healthcare/institution acquired, secondary testing includes the following organisms:

  • Sapovirus
  • Astrovirus

3.2 Acute vomiting

In the case of an outbreak of acute vomiting primary testing includes the following organisms:

  • Norovirus
  • Rotavirus
  • Adenovirus

In the case of an outbreak of acute vomiting secondary testing includes the following organisms:

  • Sapovirus
  • Astrovirus
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