Differential Yield of Pathogens from Stool Testing of Nosocomial versus Community‐Acquired Paediatric Diarrhea

Abstract

OBJECTIVES:To evaluate the role of routine stool examination for all pathogens in paediatric nosocomial diarrhea (NAD) and community-acquired diarrhea (CAD) over a two-year period at Alberta Children's Hospital and current practices in other Canadian hospitals. A secondary objective was to characterize features that may predict NAD or CAD etiology. STUDY DESIGN: Retrospective cohort study and telephone survey. SETTING: Alberta Children's Hospital (retrospective review) and Canadian tertiary care paediatric centres (telephone survey). METHODS:The health and microbiological records of all children with an admission or discharge diagnosis of diarrhea were reviewed using a standardized data collection form. In addition, a telephone survey of laboratories serving all paediatric hospitals in Canada was conducted using a standard questionnaire to obtain information about practices for screening for pathogens related to NAD. RESULTS: Four hundred and thirty-four CAD episodes and 89 NAD episodes were identified. Overall, rotavirus and Clostridium difficile were the most commonly identified pathogens. Bacterial culture was positive in 10.6% CAD episodes tested, with Escherichia coli O157:H7 identified as the most common non-C difficile organism. In NAD, no bacteria were identified other than C difficile (toxin). Screening for ova and parasites had negligible yield. Viruses were more frequent in the winter months, while bacterial pathogens were more common in the summer and fall months. Over 50% of Canadian paediatric hospitals still routinely process NAD specimens similarly to CAD specimens. CONCLUSIONS: There is a need for the re-evaluation of routine ova and parasite screening, and bacterial culture in nonoutbreak episodes of NAD in children.

Clostridium difficile Infection Seasonality: Patterns across Hemispheres and Continents – A Systematic Review

“…Despite the increasing incidence of CDI among the paediatric population [ 33 ] only one study (Deodari et al . [ 34 ]) was identified that described the CDI seasonality in children; therefore, generalizability of the findings may be limited among this population. Potential factors that may contribute to differences in monthly CDI incidence that could not be accounted for in this review, such as hospital characteristics (e.g.…”

Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

“…Studies included children aged 0-2 years (n=4), 0-5 years (n=2), 0-12 years (n=3) and 0-18 years (n= 22). The majority of studies were from North America (n=12; 6,184 cases) [13][14][15][16][17][18][19][20][21][22][23][24] and Europe (n=12; 2,467 cases) [8,[25][26][27][28][29][30][31][32][33][34][35], with other studies from Asia (n=4; 1,762 cases) [36][37][38][39], Australia (n=2; 148 cases) [40,41] and South America (n = 1; 210 cases) [42]. Ten studies included only community-onset patients [13,14,25,27,28,31,32,34,35,38], three included only hospital patients [20,30,40], 12 included both hospital and community [8, 15, 16, 19, 21-24, 26, 29, 33, 42] and six studies did not report the place of onset [17,…”

Yield of Emergency Department Stool Culture Tests Among Children With Acute Gastroenteritis in Israel

“…9 The diagnosis of bacterial AGE relies on stool cultures that have poor yield and high cost. 10,11 Therefore, a more careful selection of patients with a higher risk of bacterial infection may decrease costs and demand less labor in pediatric ED. Previous studies have attempted to predict which patients are at higher risk of bacterial AGE.…”