Background. Diarrheal disease is a leading cause of death for young children. Most pediatric gastroenteritis is caused by viral pathogens; consequently, current recommendations advocate against routine antibacterial therapy if children present without bloody stools.
Methods. In this prospective cohort study, we enrolled children with severe acute gastroenteritis admitted to hospital in Botswana. Details of presenting history, physical examination, and course in the hospital were recorded. Stool samples were characterized using a 15 pathogen polymerase chain reaction assay.
Results. There were 671 participants with a median age of 8.3 months; 77 (11%) had severe acute
malnutrition. Only 74 children had bloody stools, of whom 48 (65%) had a detectable bacterial pathogen, compared to 195 of 592 (33%) of those without. Therewere 26 deaths (3.9%). Covariates associated with death in multivariable logistic regression were the detection of any of Campylobacter/Shigella/enterotoxigenic Escherichia coli (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.07–6.17), severe acute malnutrition (OR 4.34, 95% CI 1.79–10.5), and antibiotic therapy (OR 8.82, 95% CI 2.03–38.2). There was no significant association between bloody stools and death, and the effect of Campylobacter/Shigella/enterotoxigenic E. coli infection on death was not modified by the presence of bloody stools. Conclusions. Detection of bacterial enteropathogens is associated with increased mortality in children in sub-Saharan Africa. Unfortunately, most children with these infections do not have bloody stools, and bloody dysentery was not found to be associated with worse outcomes. Clinical trials evaluating outcomes associated with more aggressive diagnostic strategies in children presenting with severe acute gastroenteritis in sub-Saharan Africa should be undertaken.

FLOQSwabs were developed out of an extensive collaboration with physicians and
clinical microbiologists, and a tireless drive to optimize the efficiency of pre-analytical
sample collection and transport. The results are optimized efficiency and
reproducibility of the target analyte collection, enhanced flow dynamics and assay
sensitivity, and expanded testing capabilities.
COPAN specialized regular flocked swabs are commonly used to collect samples for
viral or bacteriological testing. When paired with viral transport media for testing
suspected cases of COVID-19 and other viral pathogens flocked swabs offer
exceptional value and clinical outcomes to laboratories and point of care providers.
Innovative FLOQSwabs improve specimen collection and testing capabilities resulting
in better clinical care. The flocked swab tip is coated with perpendicularly sprayed on
nylon fibers. This coating creates a thin absorbent layer that allows for quick sample
uptake and elution of more than 90% of the sample. They provide quantitative
measurable and consistent sample volume transfer from patient to test tube offering
potential for improved test sensitivity.