Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

Abstract

Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID). Interviews were conducted with a semi-structured questionnaire and underwent inductive content analysis based on Grounded Theory. The questionnaire was repeatedly adapted to capture emerging themes until the point of theoretical saturation. GPs perceived AG and campylobacteriosis of little relevance to their daily work and public health in general. According to GP self-estimates each consults about two cases of AG per week and diagnoses a median of five campylobacteriosis cases per year. A large proportion of AG cases receives telephone consultations only and gets medical advice from the practice nurse. Antibiotic therapy is considered useful and stool diagnostics are performed for about a fifth of consulting AG patients. Stool diagnostics (“test”) and antibiotic therapy (“treat”) are interrelated and follow four strategies: “Wait & See”, “Treat & See”, “Treat & Test”, and “Test & See”. AG case management is diverse and includes different triage steps. A small proportion of AG patients have stool diagnostics performed and only positive tested patients are reported to the NNSID. As a result severe cases and cases with a history of travel abroad are overrepresented in the NNSID. The use of multiplex PCR panels in routine diagnostics likely leads to improved case management and higher case numbers in surveillance systems.

Enterovirus detection in patients with acute gastroenteritis in Switzerland

“…However, general practitioners in Switzerland observe Campylobacter in all age groups and patient strata. 31 Our results suggest that Campylobacter may also | 689 contribute to GE episodes in Swiss patients, and the role of hospitalacquired infections has not been rigorously assessed.…”

“…A 13 of 16 samples were contributed by patients from the stem cell ward or by children supporting the idea that Campylobacter is more likely detected in immunocompromised patients. However, general practitioners in Switzerland observe Campylobacter in all age groups and patient strata . Our results suggest that C ampylobacter may also contribute to GE episodes in Swiss patients, and the role of hospital‐acquired infections has not been rigorously assessed.…”

Food-borne and water-borne diseases under climate change in low- and middle-income countries: Further efforts needed for reducing environmental health exposure risks

“…Water-borne disease outbreaks, particularly infectious intestinal diseases, have been attributed to various pathogens, as highlighted in Table 1 (e.g. bacteria, protozoa, viruses and parasites) and drinking water system characteristics (Bless et al, 2016;Ligon and Bartram, 2016). Lack of basic hygiene and sanitation and failing infrastructure also remain as two of the greatest challenges in the global fight against water-borne disease (Ford and Hamner, 2015).…”

Acute gastroenteritis in primary care: a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella

“…As a result, the NNSID underestimates the true burden of AG because of non-notifiable pathogens causing AG. Additionally, not every patient suffering from AG presents to a physician (under-ascertainment) and, the physician does not always initiate stool diagnosis to investigate the aetiology of the illness (under-reporting) [ 8 , 9 ]. Hence, what is seen in the Swiss mandatory notification system represents only an incomplete picture of the burden of disease due to AG.…”

“…More than half of campylobacteriosis patients in a case–control study approached a physician within 3 days after onset of symptoms and 14.5% were hospitalised [ 13 ]. A subsequent qualitative survey among primary care physicians described case management approaches including treatment strategies and stool diagnostic testing behaviours from the physicians’ perspective for patients with AG [ 8 ]. Four main approaches were identified of which only two—the “test & wait” and the “test & treat” approaches—include stool specimen testing and, hence, would result in case registration in the mandatory disease surveillance system in case of a positive test outcome.…”