Bacterial gastroenteritis

Infectious diarrhoea is a major public health concern worldwide. Bacteria, the focus of this review, are responsible for 20–40% of diarrhoeal episodes, contributing to high rates of childhood mortality in developing regions, and substantial morbidity and economic losses in developed regions. The epidemiology is changing with salmonellosis decreasing in industrialized countries and diarrhoeagenic Escherichia coli contributing to an increasing burden of disease worldwide. Molecular diagnostics have improved our understanding of the epidemiology, aetiology and pathogenesis of bacterial gastroenteritis, and have revealed new pathogenic agents, although widespread introduction of such diagnostics into clinical practice will require careful cost-benefit analyses. The development of antimicrobial resistance in gastrointestinal pathogens has implications for treatment options. We review the epidemiology of infectious diarrhoea, the principal aetiological agents and their clinical features, and the diagnosis, treatment and prevention of bacterial gastroenteritis; we also propose an investigation and management algorithm.