• Clinical science
  • Clinician

Bacterial gastroenteritis


Bacterial gastroenteritis is caused by a variety of organisms, including Campylobacter, Salmonella, Shigella, Yersinia, Vibrio cholerae, Staphylococcus aureus, diarrheagenic Escherichia coli, Clostridium difficile, Clostridium perfringens, and noncholera Vibrio species. Infection may be foodborne, fecal-oral, or involve direct or indirect animal transmission. Clinical features can be mild, manifesting as abdominal pain and diarrhea, or severe, including vomiting and watery or inflammatory diarrhea, fever, and hypotension. Stool analysis may reveal leukocytes or blood in certain cases. Stool cultures may be considered in severe gastroenteritis. Bacterial gastroenteritis is usually self-limiting and only requires supportive therapy. However, antibiotics are indicated when supportive therapy does not suffice or in immunosuppressed patients. Adequate food and water hygiene is crucial for preventing disease.


Overview of bacterial gastroenteritis
Pathogen Pathophysiology Associations Stool findings
Secretory diarrhea
Bacillus cereus
  • Rice, vomiting
  • WBC negative
  • No blood
  • Recent travel (e.g., Asia, Africa, the Middle East, Mexico, Central, and South America)
Clostridium perfringens
  • Undercooked meat and raw legumes
Staphylococcus aureus
  • Inadequately refrigerated food
Vibrio cholerae
Invasive diarrhea
  • Pathogens penetrate the mucosa and invade the reticuloendothelial system of the distal small intestineenteric fever
  • WBC positive (fecal mononuclear leukocytes)
  • Blood may be present
Salmonella typhi or paratyphi
Inflammatory diarrhea
  • Bacteria or cytotoxins damage the colonic mucosablood in stool and fever
  • Most common bacterial organism pathogen responsible for foodborne gastroenteritis in the US
  • Undercooked meat; most common association with hemolytic-uremic syndrome (HUS)
Clostridium difficile
  • Second most common association with hemolytic-uremic syndrome (HUS)
Noncholera Vibrio species
  • Shellfish
Salmonella (non-typhoidal)
  • Poultry/eggs


Campylobacter enteritis (campylobacteriosis)


Salmonellosis (Salmonella gastroenteritis)


Shigellosis (bacillary dysentery)






Clostridium perfringens enterocolitis

  • Pathogen: Clostridium perfringens
  • Transmission: foodborne (undercooked or poorly refrigerated meat, legumes)
  • Incubation period: 6–24 hours
  • Clinical features
    • Duration: < 24 hours
    • Severe abdominal cramping
    • Watery diarrhea
  • Diagnosis: toxin detection in stool cultures
  • Treatment: supportive therapy only
  • Complications: clostridial necrotizing enteritis


Noncholera Vibrio infection


Acute management checklist

Trimethoprim/sulfamethoxazole is not recommended as an empiric treatment for infectious gastroenteritis because of the high prevalence of resistant organisms.