Diarrhea etiology in a children's hospital emergency department: A prospective cohort study
Diarrhea etiology in a children's hospital emergency department: A prospective cohort study
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DOI：
10.1086/507335
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发表时间：
2006-10-01
影响因子：
11.8
通讯作者：
Tarr, Phillip I.
中科院分区：
文献类型：
--
作者：
Klein, Eileen J.;Boster, Daniel R.;Tarr, Phillip I.
背景资料。我们评估了在儿科急诊科就诊的腹泻儿童病原体恢复的频率，并对相关疾病进行了表征，以制定进行肠道细菌培养的指南。我们对1998年11月至2001年10月期间在大型地区儿科急诊科就诊的所有腹泻患者进行了前瞻性队列研究。对粪便标本进行了彻底的微生物学评估，结果与病例、医生和实验室数据相关联。总共对1626份粪便样本进行了研究，以检测引起腹泻的细菌，如果粪便有足够的数量，还检测艰难梭菌毒素(688份样本)、寄生虫(656份样本)和病毒(417份样本)。176份(47%)检出细菌病原体(产志贺毒素的大肠杆菌39份[其中28份为O157：H7型]；沙门氏菌39份；弯曲杆菌25份；志贺氏菌14份；小肠结肠炎耶尔森菌2份)、病毒病原体(轮状病毒85份、星状病毒27份、腺病毒18份、轮状病毒和星状病毒8份)、致泻性寄生虫(5份)或艰难梭菌毒素(46份)。来自两名患者的样本同时产生了细菌和病毒病原体。一个识别细菌感染预测因素的模型发现，国际旅行、发烧和在前24小时内排出110次大便与细菌病原体的存在有关。医生对是否需要进行粪便培养的判断在预测细菌病原体方面几乎和模型一样准确。在到急诊科就诊的腹泻患者中，近一半的粪便标本中存在明确或可信的病原体。我们无法开发出一种比医生判断更好的模型来识别细菌培养将产生阳性结果的患者。艰难梭菌毒素出人意料的高比率需要进一步检查。
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 110 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.