Yield from stool testing of pediatric inpatients

Area of Science:

• Pediatric Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Stool testing is frequently utilized in pediatric inpatient settings.
• The diagnostic yield and cost-effectiveness of routine stool testing require evaluation.
• Identifying criteria for judicious stool testing can optimize resource allocation.

Purpose of the Study:

• To quantify the diagnostic yield of various stool tests in pediatric inpatients.
• To identify clinical criteria that can guide more selective stool testing without compromising sensitivity.
• To assess the cost implications of negative stool tests.

Main Methods:

• Retrospective review of stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays in pediatric inpatients (3 days to 18 years) over one year.
• Inclusion of positive cases with two age- and test-matched controls.
• Statistical analysis using chi-squared and Student's t-tests.

Main Results:

• Overall positive yield for stool tests was low (3.0%).
• Clostridium difficile toxin assays demonstrated the highest positive yield (18%).
• Fever (≥38°C) was associated with positive stool cultures, but missed 29% of bacterial infections; a white blood cell band count ≥0.10 was 100% sensitive for positive stool cultures.
• Clostridium difficile was the most common pathogen in patients with nosocomial gastrointestinal symptoms.

Conclusions:

• Stool testing in pediatric inpatients yields limited diagnostic information.
• Clostridium difficile toxin assays are most valuable for children with hospital-acquired gastrointestinal issues.
• Implementing selective stool testing criteria can improve efficiency and resource utilization in pediatric care.