A clinical and aetiological study of adult patients hospitalised for acute diarrhoeal disease.

Sixty adult patients with diarrhoea discharged from the infectious disease unit, Auckland Hospital in the 15 months from 1 January 1980 were reviewed. Thirty had diarrhoea due to enteric organisms (Campylobacter fetus 8, Shigella 6, Salmonella typhi 4, Salmonella typhimurium 4, Clostridium difficile causing pseudomembranous colitis 3). Other diagnoses included ulcerative colitis and a colonic carcinoma. Eighteen had no specific diagnosis. Combinations of admission fever, faecal leucocytes and leucocytosis increased the likelihood of definitive diagnosis as did prolonged diarrhoea (less than five days) in hospital. A median 3 stools per patient was examined microbiologically: in only six did a second positive follow an initial negative specimen. We now recommend only two stool specimens be examined routinely for diagnosis of enteric bacterial infection. Antibacterial drugs are infrequently needed for adult enteric bacterial diarrhoea (we treated five of 23 in hospital). Local practitioners also manage adult diarrhoea conservatively with only six of 60 patients taking antibacterials as treatment for their diarrhoea before admission.