title: Rotaviral and bacterial gastroenteritis in children during winter: an evaluation of physician ordering patterns.
abstract: BACKGROUND
  Identification of the agents of infectious diarrhea may facilitate appropriate therapy and prevent inappropriate antibiotic use.
  
  
  OBJECTIVE
  To better define the etiology of infectious diarrhea for children <12 years in our community and to study the ordering patterns of physicians.
  
  
  METHODS
  We reviewed test results of stool specimens from children <12 years old at our institution (CCF) and those submitted through our reference laboratory for rotavirus enzyme immunoassay (REIA) and stool cultures for a 7-month period (11/1/00-6/1/01). For CCF patients, REIA and stool cultures for usual bacterial enteric pathogens (BEP) were performed, regardless of the test ordered (i.e. REIA alone, stool culture alone or both). We compared the results with the orders placed to determine if requests for rotavirus alone or bacterial stool culture alone missed BEP or rotavirus, respectively.
  
  
  RESULTS
  Overall, REIAs were performed on 81% (538/661) of stool specimens, with 37% positive. Stool cultures were performed on 62% (408/661) of stool specimens, with 4.4% positive. Stool specimens (280) from CCF pediatric patients were evaluated for both rotavirus and BEP. Some 42% of REIA and 23% of stool cultures were ordered as single tests, while both tests were ordered for 35% of the patients. Of the REIA ordered alone, 34% were positive for rotavirus; however, 2.5% of these contained BEP that would have been missed. Of the stool cultures that were ordered alone, 8% were positive; however, 19% of these contained rotavirus that would have been missed. When both tests were ordered, 22% contained rotavirus and 2% contained BEP.
  
  
  CONCLUSIONS
  Both rotavirus and bacterial enteric infections were missed with selective viral versus bacterial specific ordering patterns. A rotaviral screen prior to stool culture may be useful for children with diarrhea during the winter months.
authors.affiliation: Department of Clinical Pathology, Section of Clinical Microbiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue/L40, Cleveland, OH 44185, USA.
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
authors.forename: Belinda
authors.initials: B
authors.lastname: Yen-Lieberman
authors.forename: Sue A
authors.initials: SA
authors.lastname: Schindler
authors.forename: Johanna
authors.initials: J
authors.lastname: Goldfarb
authors.forename: Gerri S
authors.initials: GS
authors.lastname: Hall
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
mesh_terms: D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis; D003968:Diarrhea, Infantile / Q000175:diagnosis; D005243:Feces / Q000382:microbiology / Q000821:virology; D005759:Gastroenteritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007753:Laboratories; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012621:Seasons