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Yield of Emergency Department Stool Culture Tests Among Children With Acute Gastroenteritis in Israel
Efrat Ben-Nun Yaari1, Ehud Rosenbloom2, Yossi Paitan3,4
1Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.
Insights
Predicting bacterial acute gastroenteritis (AGE) in children is crucial. Stool cultures may not be necessary for pediatric AGE patients without fever, bloody diarrhea, frequent stools, or seizures, improving diagnostic efficiency.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Accurate prediction of bacterial acute gastroenteritis (AGE) in children is essential for appropriate treatment.
- Existing studies on predicting positive stool cultures in pediatric AGE are limited, particularly in developed countries.
Purpose of the Study:
- To identify clinical and laboratory factors associated with positive stool cultures in pediatric patients with AGE.
- To develop criteria to determine the necessity of stool culture in emergency department settings.
Main Methods:
- Retrospective analysis of 276 pediatric patients with AGE and 560 controls.
- Evaluation of clinical factors (fever, bloody diarrhea, stool frequency, seizures) and laboratory parameters (leukocyte count, C-reactive protein).
Main Results:
- The overall positive stool sample rate was 13.7%, with *Campylobacter jejuni* being the most common pathogen.
- Bacterial AGE was significantly associated with fever >37.9°C, bloody diarrhea, increased stool frequency, seizures, and elevated CRP levels.
- Pediatric AGE patients without these indicators had a poor yield for stool culture.
Conclusions:
- Clinical and laboratory findings can help predict bacterial infections in pediatric AGE.
- Stool cultures may be unnecessary for children with AGE who do not present with fever, bloody diarrhea, frequent stools, or seizures, optimizing resource utilization.
Abstract:
Previous studies have attempted to predict a positive stool culture in pediatric patients with acute gastroenteritis (AGE), but most of them are either from developing countries or are outdated. In all, 276 patients with AGE and 560 control patients were analyzed for differences in clinical factors including the presence of fever, highest recorded temperature, bloody diarrhea, number of bowel movements in 24 hours prior to presentation, and the presence of seizures, as well as laboratory parameters including leukocyte count and C-reactive protein (CRP). Positive stool sample rate was 13.7%. The most common bacterial pathogen was Campylobacter jejuni. Bacterial AGE was significantly associated with fever >37.9°C, bloody diarrhea, higher stool passing frequency, seizures, and CRP levels. For pediatric patients who present to the emergency department with AGE and present without bloody diarrhea, fever, frequent stool passing, or seizures, a stool culture test is of poor yield and may not be necessary.
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