title: Differential yield of pathogens from stool testing of nosocomial versus community-acquired paediatric diarrhea.
abstract: OBJECTIVE
  To evaluate the role of routine stool examination for all pathogens in paediatric nosocomial diarrhea (NAD) and community-acquired diarrhea (CAD) over a two-year period at Alberta Children's Hospital and current practices in other Canadian hospitals. A secondary objective was to characterize features that may predict NAD or CAD etiology.
  
  
  METHODS
  Retrospective cohort study and telephone survey.
  
  
  METHODS
  Alberta Children's Hospital (retrospective review) and Canadian tertiary care paediatric centres (telephone survey).
  
  
  METHODS
  The health and microbiological records of all children with an admission or discharge diagnosis of diarrhea were reviewed using a standardized data collection form. In addition, a telephone survey of laboratories serving all paediatric hospitals in Canada was conducted using a standard questionnaire to obtain information about practices for screening for pathogens related to NAD.
  
  
  RESULTS
  Four hundred and thirty-four CAD episodes and 89 NAD episodes were identified. Overall, rotavirus and Clostridium difficile were the most commonly identified pathogens. Bacterial culture was positive in 10.6% CAD episodes tested, with Escherichia coli O157:H7 identified as the most common non-C difficile organism. In NAD, no bacteria were identified other than C difficile (toxin). Screening for ova and parasites had negligible yield. Viruses were more frequent in the winter months, while bacterial pathogens were more common in the summer and fall months. Over 50% of Canadian paediatric hospitals still routinely process NAD specimens similarly to CAD specimens.
  
  
  CONCLUSIONS
  There is a need for the re-evaluation of routine ova and parasite screening, and bacterial culture in nonoutbreak episodes of NAD in children.
authors.affiliation: Departments of Microbiology and Infectious Diseases, and.
authors.forename: S
authors.initials: S
authors.lastname: Deorari
authors.forename: A
authors.initials: A
authors.lastname: McConnell
authors.forename: K K
authors.initials: KK
authors.lastname: Tan
authors.forename: N
authors.initials: N
authors.lastname: Jadavji
authors.forename: D
authors.initials: D
authors.lastname: Ma
authors.forename: D
authors.initials: D
authors.lastname: Church
authors.forename: G
authors.initials: G
authors.lastname: Katzko
authors.forename: D G
authors.initials: DG
authors.lastname: Gall
authors.forename: T
authors.initials: T
authors.lastname: Jadavji
authors.forename: H D
authors.initials: HD
authors.lastname: Davies