Pathogen Spectrum And Related Factors Of Acute Infectious Diarrhea In Tianjin During 2017-2019

Objectives:We aimed to investigate the etiological characteristics,epidemiological features and risk factors of infectious diarrhea in Tianjin,and provide scientific basis for early intervention,reasonable prevention,rapid diagnosis and effective treatments of infectious diarrhea.Methods:Participants were 1114 patients with infectious diarrhea collected from 5second or first-class general hospitals and Chinese center for disease control and prevention Registry during January 1,2017 to December 31,2013.We detected stool examnation and pathogenic detection,and made a questionnaire survey for the patients.The related factors of different pathogen infectious diarrhea were analyzed by non-conditional logistic regression and the odds ratio（OR）and 95%confidence interval（CI）were calculated.We investgated the role of age,seasons,clinical characteristics and indicators of stool examination in the differential diagnosis of infectious diarrhea by operating characteristic curves.Results:1)Among 1114 patients with infectious diarrhea,599 were male（53.77%）;328 were<18 years old（29.44%）,age range was 0 years up to 93 and median age(P₂₅,P₇₅)was 25.07（1.49,41.78）.382 were≥18 and<60（34.29%）,and 130 were>60;122 infectious diarrhea in spring（10.95%）,668 in summer（59.96%）;276 in autumn（24.78%）and 48 in winter（4.31%）;920 had vomit（82.88%）;289 had a fever（26.47%）;673 had loose stools（60.47%）;943 had white blood cell（87.47%）and 224 had red blood cell（21.03%）in stools.2)Total positive rate of pathogens was 40.84%and decreased with age(x²_trend=6.203,P_trend=0.013).Positive rate of virus was 25.43%and decreased with age(x²_trend=28.852,P_trend<0.001).Norovirus,Rotavirus and Enteric adenovirus were the most prevalent.Positive rate of bacterium was 22.12%.And nontyphoidal Salmonella,Vibrio parahaemolyticus and Vibrio cholerae were the most prevelent.206 patients had multi-infection（45.27%of patients with positive pathogens）.The highest positive rate was from Norovirus plus nontyphoidal Salmonella.3)Positive rates of virus were 12.27%,23.01%,and 36.27%,respectively,and increased with years(x²_tend=57.9143,P_trend<0.001).Positive rates of bacterium were7.06%,21.43%and 32.84%,respectively,and increased with years(x²_tend=6870.61,P_trend<0.001).Top 6 of total positive rate of pathogens in 2017 were Norovirus,Vibrio parahaemolyticus,Saporovirus,Astrovirus,nontyphoidal Salmonella and Aeromonas hydrophila.Top 6 of total positive rate of pathogens in 2019 were Norovirus,Enteric Adenovirus,Rotavirus,nontyphoidal Salmonella,Vibrio parahaemolyticus and Astrovirus.Ranking list of total positive rate of pathogens during2017-2019 suggested that Norovirus came first and Vibrio parahaemolyticus and Astrovirus declined in ranking.4)In multi-adjusted logistic regression analysis,patients were 2-5 years old and with liquid stools,respiratory symptom,and negative white blood cell in stools and suffered in winter and spring were more likely viral infectious diarrhea.Patients suffered in summer and autumn and were with red blood cell in stools were more likely bacterial infectious diarrhea.Conclusions:Infectious diarrhea was most prevelant in summer and lowest in winter.The main pathogenic bacteria were Norovirus,Rotavirus and Enteric adenovirus and the main pathogenic virus were nontyphoidal Salmonella,Vibrio parahaemolyticus and Vibrio cholerae.Compared with patients with viral infectious diarrhea,summer,autumn,≥1 white blood cell and≥5 red blood cells per field in stools detection were associated with increased risk of bacterial infectious diarrhea.However,liquid stools were associated with lower risk of bacterial infectious diarrhea.Among patients with infectious diarrhea,total positive rate of pathogens was high,and nearly half of patients with positive pathogens had multi-infection.Top 3 of positive rate of virus were Norovirus,Rotavirus and Enteric Adenovirus.Top 3 of positive rate of bacterium were nontyphoidal Salmonella,Vibrio parahaemolyticus and Vibrio cholerae.Total positive rate of pathogens increased with years during 2017-2019.Patients’age,onset of seasons,fecal property and blood cell count in stools played an important role in diagnosis of infectious diarrhea.