Hennessy Thomas W, Marcus Ruthanne, Deneen Valerie, Reddy Sudha, Vugia Duc, Townes John, Bardsley Molly, Swerdlow David, Angulo Frederick J
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Clin Infect Dis. 2004 Apr 15;38 Suppl 3:S203-11. doi: 10.1086/381588.
To understand physician practices regarding the diagnosis of acute diarrheal diseases, we conducted a survey, in 1996, of 2839 physicians in Connecticut, Georgia, Minnesota, Oregon, and California. Bacterial stool culture was requested for samples from the last patient seen for acute diarrhea by 784 (44%; 95% confidence interval, 42%-46%) of 1783 physicians. Physicians were more likely to request a culture for persons with acquired immune deficiency syndrome, bloody stools, travel to a developing country, diarrhea for >3 days, intravenous rehydration, or fever. Substantial geographic and specialty differences in culture-request practices were observed. Twenty-eight percent of physicians did not know whether stool culture included testing for Escherichia coli O157:H7; 40% did not know whether Yersinia or Vibrio species were included. These variabilities suggest a need for clinical diagnostic guidelines for diarrhea. Many physicians could benefit from education to improve their knowledge about tests included in routine stool examinations.
为了解医生对急性腹泻疾病的诊断做法，我们于1996年对康涅狄格州、佐治亚州、明尼苏达州、俄勒冈州和加利福尼亚州的2839名医生进行了一项调查。在1783名医生中，有784名（44%；95%置信区间为42%-46%）要求对最后一位因急性腹泻就诊患者的样本进行粪便细菌培养。对于患有获得性免疫缺陷综合征、便血、前往发展中国家旅行、腹泻超过3天、静脉补液或发热的患者，医生更有可能要求进行培养。在培养要求做法上观察到了显著的地理和专业差异。28%的医生不知道粪便培养是否包括对大肠杆菌O157:H7的检测；40%的医生不知道是否包括对耶尔森菌或弧菌属的检测。这些差异表明需要腹泻的临床诊断指南。许多医生可通过教育受益，以提高他们对常规粪便检查所包括检测的了解。
