Fraij Omar, Castro Neva, de Leon Castro Luis A, Brandt Lawrence J
Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY USA.
New York City Health and Hospitals Corporation (HHC), New York, NY USA.
Gut Pathog. 2020 Jun 22;12:30. doi: 10.1186/s13099-020-00369-2. eCollection 2020.
Acute gastroenteritis (AGE) is diagnosed with a presentation of > 1 episode of vomiting and > 3 episodes of diarrhea in a 24-h period. Treatment is supportive, however, in severe cases antibacterial treatment may be indicated. Stool cultures can detect the responsible pathogenic bacteria and can guide antibiotic treatment, however, the indication for and efficacy of stool cultures is debatable. This study aimed to address the clinical utility of stool cultures in patients diagnosed with AGE.
A retrospective, multicenter study was performed in patients admitted for AGE from 2012 to 2014. Patient charts were obtained through hospital software using ICD-9 codes for AGE. Inclusion criteria was a documented diagnosis of AGE, age of 18 years or older, symptoms of both upper GI symptoms of abdominal pain and/or nausea and lower GI symptoms of diarrhea. Patients were classified into two main groups, those in whom (1) stool culture was obtained and (2) those in whom stool culture was not performed. Clinical features and outcomes were compared between groups. The diagnostic yield of stool cultures was assessed. All analysis were conducted using the Statistical Package for Social Science (SPSS).
Of 2479 patient charts reviewed, 342 met the above criteria for AGE. 119 patients (34.8%) had stool cultures collected and 223 (65.2%) did not. Demographics, clinical features and serologic lab values are shown in Table 1. Of the 119 stool cultures performed, only 4% (n = 5) yielded growth of pathogenic bacteria (2 Pseudomonas spp, 2 Campylobacter spp, 1 Salmonella spp). The group who underwent stool culture had a higher percentage of patients with fevers (26% vs 13%, < 0.003) and longer hospital length of stay (3.15 vs 2.28 days, < 0.001) compared to the group that did not undergo stool cultures.
Stool cultures are commonly ordered when AGE is suspected. In our cohort, stool culture had a very low yield of detecting an underlying pathogen. Although patients who had stool cultures obtained were more likely to be febrile and to have a longer length of hospital stay than were those who did not have stool cultures, for the vast majority of patients, stool culture played little to no role in patient management. Further studies are needed to which patients benefit most from undergoing stool culture.
急性胃肠炎（AGE）的诊断标准为24小时内出现1次以上呕吐和3次以上腹泻。治疗以支持治疗为主，但在严重病例中可能需要抗菌治疗。粪便培养可检测出致病细菌并指导抗生素治疗，然而，粪便培养的指征和疗效存在争议。本研究旨在探讨粪便培养在诊断为AGE的患者中的临床应用价值。
对2012年至2014年因AGE入院的患者进行一项回顾性多中心研究。通过医院软件使用AGE的ICD-9编码获取患者病历。纳入标准为记录在案的AGE诊断、年龄18岁及以上、有上消化道腹痛和/或恶心症状以及下消化道腹泻症状。患者分为两个主要组，一组（1）进行了粪便培养，另一组（2）未进行粪便培养。比较两组的临床特征和结局。评估粪便培养的诊断阳性率。所有分析均使用社会科学统计软件包（SPSS）进行。
在审查的2479份患者病历中,342份符合上述AGE标准。119例患者（3 . 48%）进行了粪便培养，223例（65 . 2%）未进行。人口统计学、临床特征和血清学实验室值见表1。在进行的119次粪便培养中，只有4%（n = 5）培养出致病细菌生长（2株假单胞菌属、2株弯曲杆菌属、1株沙门菌属）。与未进行粪便培养的组相比，进行粪便培养的组中发热患者的百分比更高（26%对13%，< 0 . 003），住院时间更长（3 . 15天对2 . 28天，< 0 . 001）。
怀疑AGE时通常会进行粪便培养我们的队列研究中，粪便培养检测出潜在病原体的阳性率非常低。虽然进行粪便培养的患者比未进行粪便培养的患者更有可能发热且住院时间更长，但对于绝大多数患者来说，粪便培养在患者管理中几乎没有作用。需要进一步研究哪些患者从粪便培养中获益最大。
