Morris A J, Wilson M L, Reller L B
Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina.
J Clin Microbiol. 1992 Dec;30(12):3213-6. doi: 10.1128/jcm.30.12.3213-3216.1992.
We retrospectively determined the yield of 2,015 stool ovum and parasite (O&P) examinations performed over an 11-month period. Two aspects were evaluated: the yield of positive results from multiple specimens per patient versus the result of a single examination, and the yield of positive results from stools submitted after 3 days of hospitalization. There were 131 (6.7%) positive O&P examinations from 75 patients: for 35 patients the single examination was positive; for 18, two of two examinations were positive; and for 15, three of three examinations were positive. The remaining seven patients had at least one negative examination in a series, but pathogenic intestinal parasites were detected in only three of these patients. Seventeen patients with positive O&P examinations were inpatients: seven of nine patients examined for O&P within 3 days of admission had stool specimens that contained recognized pathogens, in contrast to only two of eight patients examined after 3 days of hospitalization. After reviewing the data and informing hospital clinics, wards, and physicians, we instituted the following policy for screening stool specimens submitted for O&P examination. Only one O&P examination was performed for each outpatient visit and for inpatients hospitalized for 3 days or less, and examinations were not performed on stools submitted after 3 days of hospitalization unless the clinician arranged for the examination on the basis of clinical need. Over the 6-month follow-up period, 29.9% of O&P requests were rejected, 22% for patients in hospital for longer than 3 days and 7.9% for multiple O&P requests. Of 265 initially rejected specimens, 22 (8.3%) were examined after the referring physician contacted the laboratory. None of these specimens was positive. We conclude that eliminating O&P examinations of patients hospitalized for more than 3 days and initially performing only one examination per patient significantly reduces the number of examinations performed and reduces laboratory charges without adversely affecting patient care.
我们回顾性地确定了在11个月期间进行的2015次粪便虫卵和寄生虫（O&P）检查的阳性率。评估了两个方面：每位患者多次标本的阳性结果率与单次检查结果率，以及住院3天后提交粪便的阳性结果率。75例患者中有131次（6.7%）O&P检查呈阳性：35例患者单次检查呈阳性；18例患者两次检查均呈阳性；15例患者三次检查均呈阳性。其余7例患者在一系列检查中至少有一次阴性，但这些患者中只有3例检测到致病性肠道寄生虫。17例O&P检查呈阳性的患者为住院患者：入院3天内接受O&P检查的9例患者中有7例粪便标本含有公认的病原体，相比之下，住院3天后接受检查的8例患者中只有2例。在审查数据并通知医院诊所、病房和医生后，我们制定了以下筛查提交进行O&P检查的粪便标本的政策。每次门诊就诊和住院3天或更短时间的住院患者仅进行一次O&P检查，住院3天后提交的粪便不进行检查，除非临床医生根据临床需要安排检查。在6个月的随访期内，29.9%的O&P检查申请被拒绝，住院超过3天的患者中有22%，多次O&P检查申请中有7.9%。在265例最初被拒绝的标本中，22例（8.3%）在转诊医生联系实验室后进行了检查。这些标本均无阳性结果。我们得出结论，取消对住院超过3天患者的O&P检查，且最初每位患者仅进行一次检查，可显著减少检查次数并降低实验室费用，而不会对患者护理产生不利影响。
