Meropol S B, Luberti A A, De Jong A R
Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
Arch Pediatr Adolesc Med. 1997 Feb;151(2):142-5. doi: 10.1001/archpedi.1997.02170390032006.
To quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity.
A retrospective review was performed of all stool cultures, ova and parasite examinations, and Clostridium [correction of Clostridia] difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Philadelphia, Pa, for 1 year. Medical records were reviewed for positive cases, each with 2 controls matched for age and test type. For this study, the term admission refers to the interval between the times each patient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admission; some patients had more than 1 admission during the study period. Statistical analysis was performed using X2 analysis and the Student 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia).
Of 250 patient admissions to the hospital for which stool was cultured, 7 cultures (2.8%) were positive. Of 63 patient admissions having ova and parasite testing, 1 (2%) had a positive result. Clostridium [correction of Clostridia] difficile toxin assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test results reviewed were positive. Costs of negative test results totaled $26,084. More patients (71%) with positive stool cultures than control patients (21%) had a temperature higher than or equal to 38 degrees C (X2, P < .05); however, relying on this sign missed 29% of the children with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relationship between stool culture results and age, total white blood cell count or white blood cell segmented neutrophil count, and no relationship between C. difficile toxin assay results and any of the above characteristics. Clostridium [correction of Clostridia] difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admission; however, Salmonella enteritidis and Shigella sonnei were also significant causes (3 of 9).
There is low yield from stool testing of pediatric inpatients: C. difficile toxin assay has the highest yield. Clostridium [correction of Clostridia] difficile testing is most valuable for children with nosocomial gastrointestinal symptoms although other bacterial pathogens do cause nosocomial symptoms in children. More selective stool testing could help us be more efficient with our patient care resources.
量化儿科住院患者粪便检测的阳性率，并确定在不牺牲诊断敏感性的情况下更有针对性地进行粪便检测的标准。
对宾夕法尼亚州费城托马斯·杰斐逊大学医院1年内对年龄在3天至18岁的儿科住院患者进行的所有粪便培养、虫卵及寄生虫检查和艰难梭菌毒素检测进行回顾性研究。查阅病历中的阳性病例，每个病例匹配2名年龄和检测类型相同的对照。本研究中，入院期是指每位患者入院至出院的时间段。一些患者在单次住院期间多次送检粪便样本；一些患者在研究期间有多次入院。使用X²分析和双侧t检验，通过商用统计软件包（Statworks，Cricket Software，费城）进行统计分析。
在250例住院患者中进行了粪便培养，7例培养结果阳性（2.8%）。在63例进行虫卵及寄生虫检测的住院患者中，1例结果阳性（2%）。对40例住院患者进行了艰难梭菌毒素检测，7例结果阳性（18%）。在所有598项检测结果中，仅18项（3.0%）为阳性。阴性检测结果的费用总计26,084美元。粪便培养阳性的患者中，体温高于或等于38℃的患者比例（71%）高于对照患者（21%）（X²检验，P < 0.05）；然而，仅依靠这一指标会漏诊29%的细菌感染儿童。白细胞杆状核计数至少为0.10在识别粪便培养阳性患者方面敏感性为100%，特异性为79%。粪便培养结果与年龄、白细胞总数或白细胞分叶核中性粒细胞计数之间无统计学显著关系，艰难梭菌毒素检测结果与上述任何特征之间也无关系。在入院后出现胃肠道症状的患者中，艰难梭菌是最常见的病原体（9例中的6例）；然而，肠炎沙门菌和宋内志贺菌也是重要病因（9例中的3例）。
儿科住院患者粪便检测的阳性率较低：艰难梭菌毒素检测的阳性率最高。艰难梭菌检测对有医院获得性胃肠道症状的儿童最有价值，尽管其他细菌病原体也会导致儿童出现医院获得性症状。更具选择性的粪便检测有助于我们更有效地利用患者护理资源。
