{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T04:25:18Z","timestamp":1760502318229,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,4,11]],"date-time":"2021-04-11T00:00:00Z","timestamp":1618099200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Co\u2010infections with viral and bacterial enteropathogens often augment severity of diarrhoea, however, there is limited evidence on the clinical importance of bacterial enteric co\u2010infections. We investigated the rate, type and impact of bacterial enteropathogens and their associations in children with gastroenteritis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study that included children 0\u201318\u00a0years old with acute bacterial diarrhoea during a 27\u2010year period (1993\u20132019), in Crete, Greece. Differences in clinical characteristics and pathogen associations were investigated between single and multiple infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two or more bacteria were isolated in stool culture in 53 out of 1932 children (2.74%). Patients with co\u2010infections were younger (<jats:italic>p<\/jats:italic> 0.0001) and had higher hospitalisation rates (<jats:italic>p<\/jats:italic> 0.03). <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>E.\u00a0coli)<\/jats:italic> was the most prevalent pathogen associated with co\u2010infections, in particular the <jats:italic>E.\u00a0coli<\/jats:italic> enteropathogenic strains O127 and O111 (<jats:italic>p<\/jats:italic> 0.001), and <jats:italic>Salmonella<\/jats:italic> spp the least (<jats:italic>p<\/jats:italic> 0.001). Co\u2010occurrence analysis revealed two positively associated pathogen pairs, <jats:italic>E.\u00a0coli<\/jats:italic> with <jats:italic>Campylobacter<\/jats:italic> spp and <jats:italic>E.\u00a0coli<\/jats:italic> (<jats:italic>p<\/jats:italic> 0.001) with <jats:italic>Salmonella<\/jats:italic> spp (<jats:italic>p<\/jats:italic> 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bacterial enteropathogen co\u2010infection was most common with <jats:italic>E.\u00a0coli<\/jats:italic> strains and related to higher hospitalisation rates and younger age.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.15854","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T17:49:26Z","timestamp":1616521766000},"page":"2240-2245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Polymicrobial gastroenteritis in children"],"prefix":"10.1111","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4026-0328","authenticated-orcid":false,"given":"Eleni","family":"Vergadi","sequence":"first","affiliation":[{"name":"Department of Paediatrics, University General Hospital of Heraklion, Medical School University of Crete Heraklion Crete Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Maraki","sequence":"additional","affiliation":[{"name":"Department of Microbiology University General Hospital of Heraklion Heraklion Crete Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelia","family":"Dardamani","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University General Hospital of Heraklion, Medical School University of Crete Heraklion Crete Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1090-3698","authenticated-orcid":false,"given":"Fani","family":"Ladomenou","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Venizeleion General Hospital of Heraklion Heraklion Crete Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanouil","family":"Galanakis","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University General Hospital of Heraklion, Medical School University of Crete Heraklion Crete Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000096"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-016-0157-2"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws220"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-13-36"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.17-0473"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-015-2367-0"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70808-4"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000448"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001781"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-013-1825-9"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-020-0713-6"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/9781555816728.ch16"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.39.6.2134-2139.2001"},{"key":"e_1_2_9_15_1","first-page":"316","article-title":"Acute gastroenteritis due to double infection with enteropathogenic Escherichia coli or Salmonella and another bacterial pathogen","volume":"26","author":"Eshel G","year":"1990","journal-title":"Isr J Med Sci"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.14202\/vetworld.2019.224-230"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.12.018"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2672.2001.01377.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006956"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00031-16"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)92337-H"},{"key":"e_1_2_9_22_1","first-page":"125","article-title":"Escherichia coli O127:B8, a pathogenic strain causing infantile diarrhea. I. Epidemiology and bacteriology of a prolonged outbreak in a premature nursery","volume":"90","author":"Stulberg CS","year":"1955","journal-title":"AMA Am J Dis Child"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31529-X"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.02318"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.55.11.2816-2821.1987"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001717"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2018.12.003"}],"container-title":["Acta Paediatrica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apa.15854","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apa.15854","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apa.15854","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T08:52:23Z","timestamp":1693385543000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apa.15854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,11]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1111\/apa.15854"],"URL":"https:\/\/doi.org\/10.1111\/apa.15854","archive":["Portico"],"relation":{},"ISSN":["0803-5253","1651-2227"],"issn-type":[{"type":"print","value":"0803-5253"},{"type":"electronic","value":"1651-2227"}],"subject":[],"published":{"date-parts":[[2021,4,11]]},"assertion":[{"value":"2020-12-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}