Bacterial gastroenteritis is an inflammatory condition of the gastrointestinal tract caused by bacterial pathogens. It is characterized by a sudden onset of diarrhea, abdominal cramping, nausea, vomiting, and often fever.
Impacts of this condition can range from mild and self-limiting to serious and life-threatening, especially in more susceptible populations such as infants, older adults, and people with compromised immune systems. In these populations, bacterial gastroenteritis can result in serious complications, including dehydration, electrolyte imbalance, or even sepsis.
This condition typically results from the ingestion of contaminated food or water or from person-to-person contact. Nurses help manage bacterial gastroenteritis by performing early recognition, assessing hydration status, managing symptoms, educating patients and caregivers, and enforcing infection control measures in both community and healthcare settings.
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Bacterial gastroenteritis is caused by a variety of pathogens, most commonly:
- Escherichia coli (E. coli), including shiga toxin-producing strains (STEC)
- Salmonella spp.
- Shigella spp.
- Campylobacter jejuni
- Vibrio cholerae
- Yersinia enterocolitica
- Staphylococcus (found in dairy products, meat, and eggs)
- Clostridioides difficile (C. diff)
These organisms may produce enterotoxins, proteins that disrupt intestinal fluid balance by stimulating secretion or inhibiting absorption, resulting in profuse, watery diarrhea.
Alternatively, some bacteria directly invade and damage the intestinal mucosa, triggering a more inflammatory response characterized by abdominal pain, fever, and bloody or mucoid stools. The clinical manifestations depend on the specific pathogen involved, the host’s immune status, and the extent of toxin-mediated or invasive activity within the gastrointestinal tract.
Transmission
- Fecal-oral route, where pathogens from fecal matter are ingested via contaminated hands, food, or surfaces
- Consumption of contaminated or undercooked food and water (Frozen or refrigerated foods that aren’t stored at the proper temperature or aren’t reheated properly. Food left out of the refrigerator too long.)
- Inadequate hand hygiene and poor food handling
- Secondary spread via contact with infected individuals or contaminated surfaces
Risk factors
- International travel to regions with poor sanitation (traveler’s diarrhea)
- Consumption of raw or undercooked meat, poultry, seafood, or unpasteurized dairy
- Exposure to untreated water from lakes, rivers, or wells
- Attending daycare or residing in institutions
- Underlying chronic illness, malnutrition, or immunodeficiency
- Improper food storage
ICD-10 code
- A09: Infectious gastroenteritis and colitis, unspecified
- Specific codes are available depending on the confirmed organism:
- A04.0: Enteropathogenic E. coli infection
- A04.5: Campylobacter enteritis
- A04.07: Clostridium difficile
- A03.0: Shigellosis due to Shigella dysenteriae
- A02.0: Salmonella enteritis
Assessment
Clinical suspicion is typically raised by characteristic symptoms, such as acute diarrhea, abdominal cramping, and systemic signs of infection.
A thorough history should include recent travel, dietary exposures, contact with symptomatic individuals, and recent antibiotic use. Physical findings are assessed in conjunction with stool testing, blood work, and occasionally imaging to confirm the diagnosis, identify the causative organism, and guide therapeutic interventions.
Clinical presentation
- Acute onset of diarrhea, which may be watery or bloody depending on the pathogen
- Abdominal cramps and tenderness
- Nausea and vomiting
- Low-grade to high fever
- Malaise and fatigue
- Symptoms of dehydration such as dry mucous membranes, sunken eyes, and decreased urination
Diagnostic evaluation
- Comprehensive history, including recent food intake, travel, and exposure to sick contacts
- Physical examination to assess hydration status, abdominal findings, and systemic symptoms
- Stool culture and sensitivity to identify bacterial pathogens and guide antibiotic therapy
- Rapid antigen tests and PCR-based assays to detect common enteric bacteria and their toxins
- Stool analysis for leukocytes or lactoferrin as a marker of intestinal inflammation
- Blood tests (CBC, BUN, creatinine, electrolytes) to evaluate severity, renal function, and electrolyte disturbances
Management
The management of bacterial gastroenteritis centers around restoring and maintaining hydration, correcting electrolyte imbalances, and treating the underlying infection when necessary. Because the disease spectrum ranges from mild, self-limiting illness to serious, life-threatening dehydration and systemic complications, treatment must be tailored to the severity of the case and the needs of the patient.
Nurses and other clinicians must remain vigilant in monitoring patients' fluid status, laboratory markers, and potential complications, especially in high-risk populations such as young children, older adults, and immunocompromised individuals.
Supportive treatment
- Oral rehydration therapy (ORT): This is indicated for mild to moderate dehydration, particularly in children. Use WHO-recommended or commercially available rehydration solutions to restore fluid and electrolyte balance.
- Intravenous fluid replacement: This is required for severe dehydration, persistent vomiting, or shock. Isotonic crystalloids such as normal saline or lactated Ringer’s are typically used. Monitor fluid intake and urine output.
- Electrolyte correction: Correct specific imbalances (e.g., hyponatremia, hypokalemia) based on lab values is beneficial, particularly in patients with large-volume diarrhea.
- Treat underlying cause: Initiate antibiotic therapy based on stool culture and clinical condition when indicated.
Antibiotic therapy
- This is generally not indicated for mild, self-limiting infections.
- This is reserved for moderate to severe infections, high-risk patients (older adults, immunocompromised), or confirmed cases of Shigella, Campylobacter, or enteroinvasive E. coli.
- Avoid antibiotics in cases of STEC (e.g., E. coli O157:H7) due to the risk of hemolytic uremic syndrome (HUS).
- Empiric antibiotic choices may include azithromycin, ciprofloxacin, or ceftriaxone depending on suspected organism and local resistance patterns.
Nursing care plan
Nursing care for patients with bacterial gastroenteritis focuses on managing acute symptoms, preventing dehydration and electrolyte disturbances, and reducing the spread of infection. Nurses must quickly assess patients’ fluid status, bowel function, and vital signs to detect complications early.
Ongoing education and infection control support are key responsibilities to ensure patient safety and reduce community transmission. A patient-centered, evidence-based care plan that adapts to the severity and etiology of the infection is essential in achieving optimal outcomes.
Nursing considerations
- Monitor fluid and electrolyte status frequently, including intake and output, serum lab values, and signs of clinical dehydration.
- Implement contact precautions to prevent cross-contamination and hospital-acquired outbreaks.
- Educate patients and families on hygiene, safe food practices, and when to seek medical attention.
- Support dietary progression based on patient tolerance, beginning with clear fluids and advancing to bland, low-fiber foods.
Assessment
- Document stool frequency, consistency, color, and presence of blood or mucus.
- Monitor vital signs closely. Tachycardia, hypotension, and fever may indicate systemic involvement.
- Assess skin turgor, capillary refill, mucous membranes, and urine output for hydration status.
- Evaluate for signs of complications, such as toxic megacolon, acute kidney injury, or mental status changes.
Nursing diagnosis/risk for
- Risk for deficient fluid volume related to excessive gastrointestinal losses
- Risk for electrolyte imbalance due to diarrhea and vomiting
- Risk for impaired skin integrity (especially in perianal area)
- Risk for infection transmission related to poor hygiene or shared facilities
Interventions
- Administer prescribed oral or IV fluids and monitor response to therapy.
- Maintain strict intake/output charting, daily weights, and documentation of stool output.
- Provide skin care to prevent breakdown from frequent diarrhea.
- Administer medications, including antipyretics and antiemetics, as ordered.
- Educate on infection control, food safety, and medication adherence.
Expected outcomes
- Patients maintain or restore normal hydration and electrolyte balance.
- Bowel function returns to baseline with resolution of infection.
- Patients and caregivers demonstrate knowledge of self-care and prevention strategies.
- Risk of transmission is minimized through education and infection control.
Individual/caregiver education
- Importance of handwashing with soap and water, especially after bathroom use and before eating or preparing food
- Safe food preparation practices, including proper cooking, refrigeration, and avoidance of high-risk items (e.g., raw seafood)
- Recognizing warning signs such as high fever, blood in stool, reduced urine output, and lethargy
- Adherence to treatment plan, including fluid intake and completion of prescribed medications
- Reintegration guidelines for school, daycare, or work after infection resolution
FAQs
Resources
References
- Centers for Disease Control and Prevention. (2024). About food safety. Retrieved from https://www.cdc.gov/food-safety/about/
- Cleveland Clinic. (n.d.). Gastroenteritis. Retrieved from https://my.clevelandclinic.org/health/diseases/gastroenteritis
- World Health Organization. (2024). Diarrhoeal disease. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
