BACKGROUND: We evaluated the frequency of recovery of pathogens from children with diarrhea who presented to a pediatric emergency department and characterized the associated illnesses, to develop guidelines for performing a bacterial enteric culture. METHODS: We conducted a prospective cohort study of all patients with diarrhea who presented to a large regional pediatric emergency department during the period from November 1998 through October 2001. A thorough microbiologic evaluation was performed on stool specimens, and the findings were correlated with case, physician, and laboratory data. RESULTS: A total of 1626 stool specimens were studied to detect diarrheagenic bacteria and, if there was a sufficient amount of stool, Clostridium difficile toxin (688 specimens), parasites (656 specimens), and viruses (417 specimens). One hundred seventy-six (47%) of 372 specimens that underwent complete testing yielded a bacterial pathogen (Shiga toxin-producing Escherichia coli, 39 specimens [of which 28 were serotype O157:H7]; Salmonella species, 39; Campylobacter species, 25; Shigella species, 14; and Yersinia enterocolitica, 2), a viral pathogen (rotavirus, 85 specimens; astrovirus, 27; adenovirus, 18; or rotavirus and astrovirus, 8), a diarrheagenic parasite (5 specimens); or C. difficile toxin (46 specimens). Samples from 2 patients yielded both bacterial and viral pathogens. A model to identify predictors of bacterial infection found that international travel, fever, and the passing of >10 stools in the prior 24 h were associated with the presence of a bacterial pathogen. Physician judgment regarding the need to perform a stool culture was almost as accurate as the model in predicting bacterial pathogens. CONCLUSIONS: Nearly one-half of the patients who presented to the emergency department with diarrhea had a definite or plausible pathogen in their stool specimens. We were unable to develop a model that was substantially better than physician judgment in identifying patients for whom bacterial culture would yield positive results. The unexpectedly high rate of C. difficile toxin warrants further examination.
BACKGROUND: We evaluated the frequency of recovery of pathogens from children with diarrhea who presented to a pediatric emergency department and characterized the associated illnesses, to develop guidelines for performing a bacterial enteric culture. METHODS: We conducted a prospective cohort study of all patients with diarrhea who presented to a large regional pediatric emergency department during the period from November 1998 through October 2001. A thorough microbiologic evaluation was performed on stool specimens, and the findings were correlated with case, physician, and laboratory data. RESULTS: A total of 1626 stool specimens were studied to detect diarrheagenic bacteria and, if there was a sufficient amount of stool, Clostridium difficile toxin (688 specimens), parasites (656 specimens), and viruses (417 specimens). One hundred seventy-six (47%) of 372 specimens that underwent complete testing yielded a bacterial pathogen (Shiga toxin-producing Escherichia coli, 39 specimens [of which 28 were serotype O157:H7]; Salmonella species, 39; Campylobacter species, 25; Shigella species, 14; and Yersinia enterocolitica, 2), a viral pathogen (rotavirus, 85 specimens; astrovirus, 27; adenovirus, 18; or rotavirus and astrovirus, 8), a diarrheagenic parasite (5 specimens); or C. difficile toxin (46 specimens). Samples from 2 patients yielded both bacterial and viral pathogens. A model to identify predictors of bacterial infection found that international travel, fever, and the passing of >10 stools in the prior 24 h were associated with the presence of a bacterial pathogen. Physician judgment regarding the need to perform a stool culture was almost as accurate as the model in predicting bacterial pathogens. CONCLUSIONS: Nearly one-half of the patients who presented to the emergency department with diarrhea had a definite or plausible pathogen in their stool specimens. We were unable to develop a model that was substantially better than physician judgment in identifying patients for whom bacterial culture would yield positive results. The unexpectedly high rate of C. difficile toxin warrants further examination.
Authors: Gillian A M Tarr; Linda Chui; Bonita E Lee; Xiao-Li Pang; Samina Ali; Alberto Nettel-Aguirre; Otto G Vanderkooi; Byron M Berenger; James Dickinson; Phillip I Tarr; Steven Drews; Judy MacDonald; Kelly Kim; Stephen B Freedman Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 9.079
Authors: Monique A Foster; Junaid Iqbal; Chengxian Zhang; Rendie McHenry; Brent E Cleveland; Yesenia Romero-Herazo; Chris Fonnesbeck; Daniel C Payne; James D Chappell; Natasha Halasa; Oscar G Gómez-Duarte Journal: Diagn Microbiol Infect Dis Date: 2015-07-26 Impact factor: 2.803
Authors: Stephen B Freedman; Jianling Xie; Alberto Nettel-Aguirre; Bonita Lee; Linda Chui; Xiao-Li Pang; Ran Zhuo; Brendon Parsons; James A Dickinson; Otto G Vanderkooi; Samina Ali; Lara Osterreicher; Karen Lowerison; Phillip I Tarr Journal: Lancet Gastroenterol Hepatol Date: 2017-07-14
Authors: V Sathyendran; G N McAuliffe; T Swager; J T Freeman; S L Taylor; S A Roberts Journal: Eur J Clin Microbiol Infect Dis Date: 2014-05-09 Impact factor: 3.267
Authors: Stacy R Finkbeiner; Lori R Holtz; Yanfang Jiang; Priya Rajendran; Carl J Franz; Guoyan Zhao; Gagandeep Kang; David Wang Journal: Virol J Date: 2009-10-08 Impact factor: 4.099
Authors: Lori R Holtz; Stacy R Finkbeiner; Guoyan Zhao; Carl D Kirkwood; Rosina Girones; James M Pipas; David Wang Journal: Virol J Date: 2009-06-24 Impact factor: 4.099