title: Low yield of bacterial stool culture in children with nosocomial diarrhea.
abstract: OBJECTIVE
  To determine whether bacterial stool cultures (BSC) are useful in initial evaluation of children with symptoms of nosocomial diarrhea. To answer this question we performed a retrospective record review to determine the yield of BSC in children who developed diarrhea after the third hospital day (HD-3).
  
  
  METHODS
  The hospital computer record keeping system was utilized to compile the result of BSC collected from children and adolescents ages 0 to 20 years between January 1, 1988, and October 31, 1996. All specimens were analyzed for Salmonella, Shigella, Yersinia and Campylobacter. We reviewed hospital charts of all children who developed a positive BSC beyond HD-3 to determine the time of onset of diarrhea and clinical circumstances.
  
  
  RESULTS
  A total of 11 516 BSCs were submitted from 9262 children during the 8 1/2-year period. Five hundred sixty-eight (6.6%) of 9262 children had at least 1 positive BSC. Two thousand five hundred seventy-two children had the first BSC submitted after HD-3 and 13 (0.5%) of these children had a positive result. Chart review of these 13 children demonstrated that 6 had onset of diarrhea during the first 3 hospital days. Therefore only 7 children met our criteria for having nosocomially acquired diarrhea caused by a bacterial pathogen. Children whose first BSC was submitted after HD-3 accounted for 3767 (46%) of the total 8126 inpatient BSCs and in excess of $21000 annually in patient billing charges.
  
  
  CONCLUSIONS
  In the absence of a known exposure the isolation of a bacterial pathogen from the stool of children with onset of diarrhea beyond HD-3 is a rare event. Under most circumstances BSC should not be part of the initial evaluation of children with symptoms of nosocomial diarrhea.
authors.affiliation: Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106, USA.
authors.forename: D
authors.initials: D
authors.lastname: Craven
authors.forename: D
authors.initials: D
authors.lastname: Brick
authors.forename: A
authors.initials: A
authors.lastname: Morrisey
authors.forename: M A
authors.initials: MA
authors.lastname: O'Riordan
authors.forename: V
authors.initials: V
authors.lastname: Petran
authors.forename: J R
authors.initials: JR
authors.lastname: Schreiber
mesh_terms: D000293:Adolescent; D002169:Campylobacter Infections / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000175:diagnosis; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000175:diagnosis; D015009:Yersinia Infections / Q000175:diagnosis