{"doi":"10.1093/cid/ciaf357","title":"Executive Summary: State-of-the-Art Review: Infectious Diarrhea","abstract":"This State-of-the-Art Review describes a multidisciplinary approach to the care of people with diarrhea, considering both infectious and noninfectious etiologies, from the perspectives of infectious disease, gastroenterology, microbiology, and pharmacology practitioners. Diagnostic challenges associated with caring for people with known or suspected infectious diarrhea include deciding when to perform a diagnostic test, which modality to select, how to interpret results of both molecular and nonmolecular diagnostics, the utility of diagnostics to distinguish infectious from noninfectious etiologies, and the impact on surveillance and antimicrobial resistance phenotypes with widespread use of molecular-based diagnostics. Management challenges include differentiating situations when an antimicrobial is indicated from those when an antimicrobial would not be beneficial and identifying situations when nonpharmacological interventions such as imaging may be beneficial. Treatment challenges include antimicrobial selection, especially when susceptibility data are unavailable, duration of antimicrobial therapy, managing antimicrobial adverse effects, consideration of biotherapeutics including live biotherapeutic products, such as probiotics and fecal microbiota transplantation, in the management of infectious diarrhea, particularly Clostridioides difficile infection. The diagnosis and management of people with diarrhea requires a synthesis of the history, exposures, immune status, and presentation of the person with symptoms by the clinician. The overarching goal of managing a person with diarrhea is to maintain fluid and electrolyte balance to prevent the morbidity and mortality associated with dehydration and malnutrition. A companion goal is to eliminate the discomfort associated with diarrhea, facilitating a lifestyle that is functional. In certain situations, initial management will be definitive, whereas in others, postinfectious symptoms may require a multifaceted approach. To effectively deliver care to an individual patient, it is essential to incorporate shared decision-making so that both patient and clinician are aligned with goals of care. It is also important that goals are frequently reassessed to ensure that management and treatment plans continue to meet the needs of patients and their families. This is especially relevant when caring for patients with chronic or recurrent symptoms that are dynamic. Future directions for the diagnosis and management of infectious diarrhea include opportunities to: Further develop diagnostics and biomarkers that are able to differentiate between colonization and clinically significant infection. Gain a deeper understanding of the role of live biotherapeutic products and fecal microbiota transplantation in the management of patients with infectious, postinfectious, and noninfectious diarrhea. Facilitate access to diagnostics and therapeutics related to infectious diarrhea to all who might benefit. Acknowledgments. All authors contributed to the development and focus of the manuscript including structure and development. All authors were involved in the preparation of the original and revised manuscripts and contributed to the development of figures and tables. Financial support. A. L. S. received reimbursement for travel and lodging from the International Scientific Association for Probiotics and Prebiotics to present information at international meetings (last June 2022) and her institution has received financial support that has been applied to her salary from the Bill & Melinda Gates Foundation, from the U. S. Department of Health and Human Services, Administration for Strategic Preparedness and Response as a participant in the Pediatric Disaster Centers of Excellence and the National Emerging Special Pathogens Training and Education Center and from the National Institutes of Health NCATS/NIAID U54AI150225. A. L. S. receives a stipend from the Pediatric Infectious Diseases Society fo","journal":"Clinical Infectious Diseases","year":2025,"id":549732,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9608,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":646953,"name":"Mark D. Gonzalez","orcid":null,"position":1,"is_corresponding":false},{"id":1378632,"name":"Amanda M. Roy","orcid":"0000-0001-7455-3538","position":2,"is_corresponding":false},{"id":269707,"name":"Geoffrey A. Preidis","orcid":"0000-0002-2206-6452","position":3,"is_corresponding":false},{"id":320945,"name":"Michael H. Woodworth","orcid":"0000-0002-6181-4599","position":4,"is_corresponding":false},{"id":338068,"name":"Andi L. Shane","orcid":null,"position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:54:12.321988Z","pmid":"41437888","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}