Bacterial diarrhoea

Purpose of review This review describes recent findings about the burden of bacterial diarrhoea and its potential complications, newer diagnostics, the emerging threat of multidrug resistance, and the promise of vaccines in development. Recent findings Introduction of rotavirus vaccines in over 110 countries has changed the landscape of diarrheal pathogens. In upper middle and high-income countries, the incidence of rotavirus-specific and all-cause gastroenteritis has declined substantially, and norovirus has become the major pathogen in many settings. Bacterial pathogens cause approximately 10-15% of episodes, most often Shigella, nontyphoidal Salmonella (NTS) Campylobacter and Shiga toxin-producing Escherichia coli (STEC). In lower income countries, bacterial pathogens remain a major cause of medically attended diarrhoea with Shigella, Campylobacter and enterotoxigenic Escherichia coli (ETEC) predominating. Multidrug-resistant strains of Shigella, NTS and, Campylobacter have emerged globally requiring judicious use of antibiotics according to current guidance. Management of bacterial diarrhoea includes standard fluid and electrolyte therapy, vigilance for potential complications, and use of antibiotics for children who have moderate-severe illness due to pathogens for which efficacy has been demonstrated, or for those at high risk for severe disease. The threat of multiply resistant strains provides impetus for preventive strategies such as development of vaccines.

Automated summary

This review discusses the recent burden of bacterial diarrhea, including surveillance, newer diagnostics, emerging multidrug resistance, and ongoing vaccine developments. In many settings, the introduction of rotavirus vaccines has significantly reduced the incidence of rotavirus-specific and all-cause gastroenteritis, with norovirus now becoming a major pathogen. Bacterial pathogens, such as Shigella, non-typhoidal Salmonella, Campylobacter, and Shiga toxin-producing Escherichia coli, continue to be a significant cause of diarrheal illness, particularly in lower income countries.