Bacterial gastroenteritis

Diarrhoeal disease remains an important cause of morbidity and mortality worldwide. The annual incidence of infection ranges from about one episode per five adults in industrialized countries, to five or more episodes in infants under 2 years of age in the developing world. Diarrhoea is a particularly important public health concern because of the excess mortality in children in developing countries. In the developed world, it is seldom life-threatening except in those at the extremes of age or with immune suppression. Factors associated with higher mortality from diarrhoea with a bacterial cause include malnutrition, infection with Shigella spp. or Vibrio cholerae, failure to receive adequate oral rehydration or antibiotics when indicated, and development of persistent diarrhoea. Antibiotic resistance is an increasing worldwide problem caused by overuse of antibiotics in both clinical practice and animal farming. Many of the most common and life-threatening bacteria causing diarrhoeal disease (including Shigella, Salmonella typhi and V. cholerae) are increasingly resistant to the commonly available antibiotics, particularly in the developing world. This is increasing pressure on the need for improved sanitation and the development of effective vaccines to reduce the burden of disease; however, implementation of such preventive measures cannot be guaranteed.