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Diagnostic studies of nosocomial diarrhea in children: assessing their use and value
M T Brady1, D L Pacini, C T Budde
1Department of Pediatrics, Ohio State University, Columbus.
Insights
Nosocomial diarrhea is common in children
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Nosocomial diarrhea, defined as diarrhea starting at least 72 hours after admission or within 3 days of discharge, is a significant concern in pediatric healthcare settings.
- Identifying the causative agents of hospital-acquired diarrhea is crucial for implementing effective infection control measures and patient management strategies.
Purpose of the Study:
- To investigate the incidence and causative pathogens of nosocomial diarrhea in a children's hospital over a 17-month period.
- To evaluate the utility of routine diagnostic studies in identifying pathogens responsible for nosocomial gastroenteritis in pediatric patients.
Main Methods:
- Retrospective analysis of 225 cases of nosocomial diarrhea identified between January 1985 and May 1986.
- Review of diagnostic studies performed, including bacterial stool cultures, rotavirus enzyme-linked immunosorbent assay (ELISA), Clostridium difficile toxin assays, and ova/parasite examinations.
- Correlation of pathogen detection with patient demographics, seasonality, and antibiotic exposure.
Main Results:
- Bacterial pathogens were not detected in any of the routine stool cultures.
- Rotavirus was the most frequently identified pathogen, detected in 45% of tested samples, primarily in children under two years old during winter and spring.
- Clostridium difficile toxin was detected in 17% of tested samples, with all positive cases linked to recent antibiotic use. Enteric adenovirus was identified in six patients. Viruses accounted for 42% of all identified pathogens.
Conclusions:
- Nosocomial diarrhea is prevalent in pediatric hospitals, with viral agents, particularly rotavirus, being the most common cause.
- Rotavirus testing is highly valuable for children under two with nosocomial diarrhea, especially during colder months, and multiple samples may improve detection rates.
- Clostridium difficile toxin assays should be considered for pediatric patients with a history of antibiotic exposure.
Abstract:
During a 17-month period (01/11/85-05/31/86) 225 cases of nosocomial diarrhea were identified in a children's hospital. Diarrhea was considered to be nosocomial if it began at least 72 hours after the patient's hospital admission or within 3 days after discharge. One or more routine diagnostic studies for identification of a pathogen were performed in 195 (87%) cases. The most commonly performed test was the bacterial stool culture. None of these samples yielded a bacterial pathogen. The only pathogens detected by routine laboratory studies were rotavirus (61/137 [45%] samples were positive for rotavirus by ELISA) and Clostridium difficile (9/54 [17%] positive for toxin). Of the patients whose tests were positive for rotavirus 56 were younger than 2 years of age, and all were identified in the winter and spring. When multiple stool samples were tested by the diagnostic laboratory, rotavirus was identified in an additional 14 patients whose initial stool samples were negative for rotavirus. All patients whose tests were positive for C. difficile toxin had received antibiotics within the previous 3 months. Ova/parasites were not detected in 53 of the tested stools. We also identified enteric adenovirus in six patients. Viruses were identified in 95 (42%) of the 225 cases of nosocomial gastroenteritis. Nosocomial diarrhea is common in a children's hospital. Rotavirus is the most commonly identified pathogen. Rotavirus testing is valuable in children with nosocomial diarrhea who are younger than 2 years of age, especially in the winter and spring. Multiple samples may be necessary to identify rotavirus. C. difficile toxin assay should be considered for patients who are receiving or who have received antibiotics.(ABSTRACT TRUNCATED AT 250 WORDS)