Craven D, Brick D, Morrisey A, O'Riordan M A, Petran V, Schreiber J R
Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106, USA.
Pediatr Infect Dis J. 1998 Nov;17(11):1040-4. doi: 10.1097/00006454-199811000-00015.
To determine whether bacterial stool cultures (BSC) are useful in initial evaluation of children with symptoms of nosocomial diarrhea. To answer this question we performed a retrospective record review to determine the yield of BSC in children who developed diarrhea after the third hospital day (HD-3).
The hospital computer record keeping system was utilized to compile the result of BSC collected from children and adolescents ages 0 to 20 years between January 1, 1988, and October 31, 1996. All specimens were analyzed for Salmonella, Shigella, Yersinia and Campylobacter. We reviewed hospital charts of all children who developed a positive BSC beyond HD-3 to determine the time of onset of diarrhea and clinical circumstances.
A total of 11 516 BSCs were submitted from 9262 children during the 8 1/2-year period. Five hundred sixty-eight (6.6%) of 9262 children had at least 1 positive BSC. Two thousand five hundred seventy-two children had the first BSC submitted after HD-3 and 13 (0.5%) of these children had a positive result. Chart review of these 13 children demonstrated that 6 had onset of diarrhea during the first 3 hospital days. Therefore only 7 children met our criteria for having nosocomially acquired diarrhea caused by a bacterial pathogen. Children whose first BSC was submitted after HD-3 accounted for 3767 (46%) of the total 8126 inpatient BSCs and in excess of $21000 annually in patient billing charges.
In the absence of a known exposure the isolation of a bacterial pathogen from the stool of children with onset of diarrhea beyond HD-3 is a rare event. Under most circumstances BSC should not be part of the initial evaluation of children with symptoms of nosocomial diarrhea.
确定粪便细菌培养（BSC）对医院获得性腹泻症状儿童的初始评估是否有用。为回答这个问题，我们进行了一项回顾性记录审查，以确定在住院第三天（HD - 3）后出现腹泻的儿童中BSC的阳性率。
利用医院计算机记录保存系统，汇总1988年1月1日至1996年10月31日期间收集的0至20岁儿童和青少年的BSC结果。所有标本均检测沙门氏菌、志贺氏菌、耶尔森氏菌和弯曲杆菌。我们审查了所有在HD - 3之后BSC呈阳性的儿童的医院病历，以确定腹泻发作时间和临床情况。
在8年半的时间里，9262名儿童共提交了11516份BSC。9262名儿童中有568名（6.6%）至少有1份BSC呈阳性。2572名儿童在HD - 3之后首次提交BSC，其中13名（0.5%）结果呈阳性。对这13名儿童的病历审查表明，6名儿童在住院的前3天出现腹泻。因此，只有7名儿童符合我们关于医院获得性细菌性腹泻的标准。首次BSC在HD - 3之后提交的儿童占8126份住院BSC总数的3767份（46%），每年患者计费超过21000美元。
在没有已知暴露的情况下，从腹泻发作时间超过HD - 3的儿童粪便中分离出细菌病原体是罕见事件。在大多数情况下，BSC不应作为医院获得性腹泻症状儿童初始评估的一部分。
