Performance of stool cultures before and after a 3-day hospitalization: fewer cultures, better for patients and for money

Abstract

We evaluated retrospectively the yield of stool culture (SC) depending on the length of hospitalization, and we characterized the patients missed by the 3-day rejection rule. SC detects bacterial enteric pathogens (Campylobacter spp., Salmonella enterica, Yersinia spp., Shigella spp.). During this 5-year study period, 13,039 SCs were requested, and 376 were positive (2.9%). The yield of SC dropped from 11.7% before 3 days of hospitalization to 0.7% after 3 days in children and 4.3% to 0.3% in adults. Finally, only 13 clinically relevant cases (0.2% of SC prescribed after 3 days) were undiagnosed by strict application of the 3-day rule. In conclusion, rejection of SC prescribed after 3 days of hospitalization allows to reduce workload by 37.8% for children and 65.7% for adults, representing a cost of €12,500 ($16,250) per year in our hospital.

Impact of the 3‐day rule for stool culture in a children's hospital

“…The applicability of the 3‐days rule in patients with underlying medical conditions is not well‐defined. Le Guern et al reported that the 3‐days rule rejection criteria would have led to missed detection of positive cultures in 13 patients with nosocomial diarrhea, 7 (54%) of whom were on chemotherapy . Our study showed similar results, albeit with a higher rate of immunosuppressed patients (80%).…”

“…Their interventions resulted in a 40%-60% decrease in stool cultures, and cost savings were estimated at €11 848-€43 620 (or $13 625-$50 163) annually for each tertiary care hospital. 1,2,4 The current study showed similar rates of reduction in sample number and cost.…”

“…There have been several studies that showed a low yield of stool cultures submitted 3 days after hospitalization in pediatric and adult populations. Their interventions resulted in a 40%–60% decrease in stool cultures, and cost savings were estimated at €11 848–€43 620 (or $13 625–$50 163) annually for each tertiary care hospital . The current study showed similar rates of reduction in sample number and cost.…”

“…The 3‐days rule (or 72‐h rule) is an accepted concept in clinical settings, in which stool cultures are only permitted for outpatients, or inpatients hospitalized within 72 h to reduce unnecessary culture. There are several studies investigating the clinical utility of the 3‐days rule that focus on the economic impact and positivity rate of stool cultures before and after introduction of the rules . However, the validity of this rule in pediatric hospitals, where many patients have underlying diseases, has not been well investigated.…”

“…There are several studies investigating the clinical utility of the 3-days rule that focus on the economic impact and positivity rate of stool cultures before and after introduction of the rules. 1,2 However, the validity of this rule in pediatric hospitals, where many patients have underlying diseases, has not been well investigated.…”