Siegel D L, Edelstein P H, Nachamkin I
Clinical Microbiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104-4283.
JAMA. 1990 Feb 16;263(7):979-82.
To assess the degree to which routine stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. During a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from the group of patients who had stool specimens submitted after 3 days of hospitalization. Analysis of laboratory work load for a 1-year period showed that specimens from this patient group contributed nearly 50% of the more than 3000 specimens received each year. In contrast, approximately 25% (range, 17% to 33%) of samples, regardless of admission status, were positive for C difficile toxin. Eliminating routine stool cultures and ova and parasite examinations on hospitalized patients would significantly reduce hospital and patient costs without altering patient care. Nationwide, such a policy might achieve a cost savings of +20 to +30 million per year.
为评估对住院患者进行常规粪便培养、虫卵及寄生虫检查以及艰难梭菌毒素检测的医嘱开具是否可能存在不当，我们开展了一项回顾性研究，以确定这些检查针对门诊患者和住院患者所采集标本的相对检出率，该检出率是入院后时间的函数。在3年期间，191份阳性粪便培养结果中仅有1份，90份虫卵及寄生虫检查阳性结果中无一例来自住院3天后提交粪便标本的患者组。对1年期间实验室工作量的分析表明，该患者组的标本占每年接收的3000多份标本的近50%。相比之下，无论入院状态如何，约25%（范围为17%至33%）的样本艰难梭菌毒素检测呈阳性。取消对住院患者的常规粪便培养及虫卵和寄生虫检查将显著降低医院和患者成本，且不会改变患者护理。在全国范围内，这样一项政策每年可能节省2000万至3000万美元。
