How incorrect diagnosis and treatment can worsen GI Infections
Stomach cramps and GI problems are an unfortunate common occurrence in our lives. We often experience these issues and try to push through them, hoping the symptoms will just resolve themselves. But sometimes we can’t ignore those problems, and we seek help. GI infections are a serious concern for young children, people over 60 years old and those who are immunocompromised (1). What happens when those GI infections are misdiagnosed or mistreated? Let’s explore this further.
What are gastrointestinal infections?
Gastrointestinal (GI) infections are any infectious disease of the GI system, usually caused by a microbe. Diarrhea is the most common symptom and is usually accompanied by nausea or vomiting, stomach cramps or a fever (1). Some common causes of GI infection are bacteria, viruses, and parasites. Examples include Shigella, Escherichia coli, Norovirus and Giardia (2).
In 2019, a staggering 6.6 billion cases of diarrheal disease were reported, some caused by GI pathogens (3). Of those cases, 1.53 million people died in the same year (4). These stats show the magnitude of the global burden GI infections have and the importance of prompt diagnosis and appropriate treatment.
What are the dangers of misdiagnosis and mistreatment of GI infections?
In this section, we will review the crucial role of accurate GI infection diagnosis and the dangers posed by mistreatment. By understanding the importance of accurate diagnosis and the potential risks associated with misdiagnosis and ineffective treatment, we can highlight the necessity of implementing proper diagnostic protocols and enhancing treatments to ensure the best possible outcomes for patients.
Patient complications
When a GI infection goes undiagnosed or is misdiagnosed, it prolongs the period of illness, leaving patients vulnerable to a range of serious health complications (5). Persistent diarrhea is a common consequence of delayed diagnosis. This not only causes discomfort but also leads to dehydration, which can rapidly escalate, and if left untreated, may require further hospitalization (6).
Moreover, the prolonged presence of GI infections may result in malnutrition which can lead to nutrient deficiencies and weight loss. Even more cause for concern, malnutrition weakens the immune system, leaving individuals more susceptible to further infections and prolonging their recovery (7).
Dangerous outcomes
Incorrect treatment can occur for multiple reasons, including selection of an antibiotic to treat a viral pathogen or selection of an ineffective antibiotic against a particular bacteria. Incorrect treatment is not just ineffective—it can be harmful. Improper treatment can lead to worsening of symptoms, prolonged illness, recurrent infections, or even death. If death doesn’t occur, incorrect treatment can still pave the way for recurrent infections (8,9). This not only extends the duration of discomfort and illness, but also affects the patient's quality of life, impacting their physical and emotional well-being.
In the case of STEC infections, an infection caused by certain Escherichia coli (E. coli) bacteria, antibiotic treatment can actually increase the likelihood of the patient developing a potentially life-threatening condition called hemolytic uremic syndrome (HUS) (10). Individuals at risk of developing HUS need to be identified early, as their prognosis is dependent on the avoidance of antimicrobials, supportive care, and close monitoring.
The symptoms of GI infections often overlap, making diagnosis and treatment challenging. A diagnosis can mean the difference between effective and potentially harmful or ineffective therapy. Molecular assays that can distinguish between STEC and other E. coli bacteria can help identify individuals at risk of severe GI infection and reduce the risk for serious complications (10).
Antibiotic resistance
The consequences of incorrect treatment go beyond the immediate impact on the patient. Inappropriate use of antibiotics, for instance, can contribute to the development of antibiotic resistance, a global health crisis that threatens the effectiveness of essential antimicrobials (11). The misuse or overuse of antibiotics in incorrect treatments promotes the emergence of drug-resistant strains of pathogens, making future infections more challenging to treat and potentially leading to increased rates of illness and death (12).
Unnecessary healthcare costs
Misdiagnosis doesn't just harm the patient—it also harms the healthcare system. Misdiagnosis of GI infections can result in significant healthcare costs. Accurate diagnosis plays a crucial role in optimizing resource allocation and reducing unnecessary expenses. By providing faster and more comprehensive results, accurate diagnosis enables informed patient workup, reducing the need for unnecessary follow-up testing and supporting earlier patient discharge (13).
One way to prevent unnecessary tests is GI panel testing. In comparison to historical controls, GI panel testing led to an average cost reduction of $293.61 per patient (excluding isolation and direct laboratory costs but including labor costs), contributing to cost savings and improved patient management (14).
The importance of increased awareness and accuracy in diagnosing and treating GI infections cannot be emphasized enough. By using robust diagnostic tools and comprehensive treatment strategies, we can improve patient outcomes and overcome challenges in the healthcare system.
References
- Fletcher, S. M., McLaws, M.-L., & Ellis, J. T. (2013). Water, sanitation and hygiene for the prevention of diarrhea. Journal of Public Health Research, 2(1), 42-53.
- Wilcox, M. H., Mooney, L., Bendall, R., Settle, C. D., & Fawley, W. N. (2008). A case-control study of community-associated Clostridium difficile infection. Journal of Antimicrobial Chemotherapy, 62(2), 388-396. https://doi.org/10.1093/jac/dkn163.
- University of Washington Institute for Health Metrics and Evaluation (healthdata.org) (2020) GBD 2019 Cause and Risk Summary: Diarrheal diseases - Level 3 cause. Retrieved from https://www.healthdata.org/results/gbd_summaries/2019/diarrheal-diseases-level-3-cause.
- Dadonite, B., Ritchie, H., & Roser, M. (2018). Diarrheal diseases. Our World in Data. Retrieved from https://ourworldindata.org/diarrheal-diseases.
- Beal, S. G., et al. (2018). Performance of the Verigene enteric pathogen panel for diagnosing gastrointestinal infections in children. Journal of Clinical Microbiology, 56(1), e01457-17.*
- Hill, R. J., Friesen, R. H., & Zello, G. A. (2014). Nutritional management of diarrhea in children. Paediatrics & Child Health, 19(9), 475-479.
- Guerrant, R. L., Oria, R. B., Moore, S. R., Oria, M. O., Lima, A. A., & Guerrant, R. L. (2001). Malnutrition as an enteric infectious disease with long-term effects on child development. Nutrition Reviews, 59(2), S108-S112.
- Lau, C. S., & Chamberlain, R. S. (2016). Proton pump inhibitors and the risk for recurrent Clostridium difficile infection. JAMA Internal Medicine, 176(6), 805-806.
- Marra, F., Lynd, L., Coombes, M., Richardson, K., Legal, M., Fitzgerald, J. M., & Marra, C. A. (2018). Does antibiotic exposure during infancy lead to development of asthma?: A systematic review and meta-analysis. Chest, 154(1), 58-68.
- CDC. Questions and Answers | E. coli. [Online]. Available: https://www.cdc.gov/ecoli/general/index.html. [Accessed: June 26, 2023].
- Spellberg, B., Bartlett, J. G., & Gilbert, D. N. (2019). The future of antibiotics and resistance. New England Journal of Medicine, 381(3), 278-279.
- Khanna, S., Pardi, D. S., & Aronson, S. L. (2012). The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Review of Gastroenterology & Hepatology, 6(6), 719-735.
- Spence, M. M. (2012). Diagnostic error in gastrointestinal infections. The American Journal of the Medical Sciences, 344(3), 187-192.
- Axelrad, J. E., et al. (2019). Performance of Verigene enteric panel in the detection of diarrheal pathogens in clinical practice. Journal of Clinical Microbiology, 57(3), e01775-18.*
* Data cited pertains to the use of a device from another manufacturer.