{
  "abstract": "Background Acute infectious diarrhea is a common cause of healthcare utilization worldwide, yet data on diagnostic testing patterns and pathogen epidemiology among adults in international healthcare settings in Southeast Asia are limited. This study evaluated laboratory investigation patterns and the etiologic spectrum of pathogens among adults presenting with acute diarrhea.Methods A retrospective cohort study was conducted at Bumrungrad International Hospital, Bangkok, Thailand (June 2018–May 2022). Adults diagnosed with acute diarrhea (ICD-10 A09.0–A09.9) were identified from EMR. Demographics, encounter type, nationality, and laboratory investigations were extracted. Utilization of stool culture (C/S), gastrointestinal pathogen panel (GPP), stool PCR, complete blood count, and electrolyte testing was evaluated. Pathogen distribution among patients undergoing stool microbiologic testing and differences by nationality and immune status were analyzed using chi-square tests. The study was approved by the Bumrungrad International Hospital Institutional Review Board (BIIRB-314-24-06-02-01).Results A total of 11,046 adult patients with acute diarrhea were identified, including 7,902 outpatients (71.5%) and 3,144 inpatients (28.5%). The cohort comprised 6,599 Thai patients (59.7%) and 4,447 non-Thai patients (40.3%), mainly from East Asia (34.3%), Europe (17.7%), North America (12.3%), Southeast Asia (12.3%), and the Middle East (12.1%).Laboratory investigations were performed in a minority of patients: stool culture in 2,501 patients (22.6%), GPP in 244 (2.2%), and stool PCR in 70 (0.6%). CBC testing occurred in 2,073 patients (18.8%) and electrolyte testing in 636 (5.8%). Testing was significantly more common among inpatients than outpatients, particularly for stool culture, CBC, and electrolyte testing (all p < 0.001).Among patients with microbiologic evaluation (n = 501), bacterial pathogens predominated, most commonly Salmonella spp. (10.6%), Aeromonas spp. (7.8%), Plesiomonas spp. (7.4%), and EPEC (6.4%). Among Thai patients, leading pathogens were Salmonella (10.9%), Aeromonas (9.4%), Plesiomonas (9.4%), and EPEC (8.3%), whereas among non-Thai patients they were Salmonella (10.2%), Aeromonas (6.0%), Campylobacter (6.0%), and Plesiomonas (5.1%). Plesiomonas infection was significantly associated with nationality (p = 0.047) and immune status (p = 0.034).Conclusions In this international cohort of adults with acute diarrhea, microbiologic testing was selectively performed in routine practice. Among tested patients, bacterial pathogens—particularly Salmonella, Aeromonas, and Plesiomonas—predominated, with Plesiomonas infection associated with nationality and immune status.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Medicine, King Mongkut’s Institute of Technology, Ladkrabang, Thailand"
      ],
      "name": "Chanyapat Pattanasuk"
    },
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Krit Pongpirul"
    },
    {
      "affiliations": [
        "Department of Medicine, Bumrungrad International Hospital, Thailand"
      ],
      "name": "Pises Pisespongsa"
    }
  ],
  "title": "IDDF2026-ABS-0292 Diagnostic utilization and pathogen spectrum of acute diarrhea in adults at an international hospital in Thailand",
  "uid": "f608f256-eb57-5739-aa32-d6c9746ede2d"
}