title: Prospective study on the overuse of blood test-guided antibiotics on patients with acute diarrhea in primary hospitals of China.
abstract: BACKGROUND
  Overuse with antibiotics in the treatment of infectious diseases has become a central focus of public health over the years. The aim of this study was to provide an up-to-date evaluation of the blood test-guided antibiotic use on patients with acute diarrhea in primary hospitals of China.
  
  
  METHODS
  A cross-sectional survey was conducted on 330 patients with acute diarrhea in Shanghai, People's Republic of China, from March 2013 to February 2016. These patients were treated with or without antibiotics based on the results of their blood tests, including examinations of C-reactive protein (CRP), white blood cells (WBC), and the percentage of neutrophils (Neu%). The infection types, which included bacterial, viral, and combination diarrhea, were determined by microbiological culture methods. Antibiotics used in non-bacterial diarrhea patients were considered misused and overused.
  
  
  RESULTS
  There were significant overall differences in the clinical characteristics and blood tests between patients with diarrhea with a bacterial infection and patients with other types of infections. The patients were divided into four grading groups (0-3) according to the number of the positive results from three blood testes (CRP, WBC, and Neu%). The misuse rates of antibiotics in each group (0-3) were 81.3%, 71.1%, 72.4%, and 64.9%, respectively.
  
  
  CONCLUSIONS
  In this prospective study, the current diagnostic criteria (CRP, WBC, and Neu%) based on blood tests are not reliable in diagnosing bacterial diarrhea or guiding antibiotics use. To limit antibiotic overuse, a rapid and accurate differentiation of bacterial diarrhea from other types of diarrhea is pivotal.
authors.affiliation: Department of Laboratory.
authors.forename: Xinghui
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Shanghai Gongli Hospital, The Second Military Medical University.
authors.forename: Xueke
authors.initials: X
authors.lastname: Tong
authors.affiliation: Department of Laboratory, Jinyang Community Health Service Center, Pudong New District.
authors.forename: Liyin
authors.initials: L
authors.lastname: Jin
authors.affiliation: Department of Infectious Diseases and Hepatology, The Affiliated Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine.
authors.forename: Minghao
authors.initials: M
authors.lastname: Ha
authors.affiliation: Department of Preventive Care, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.affiliation: Department of Laboratory.
authors.forename: Fengxia
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Laboratory.
authors.forename: Yongbin
authors.initials: Y
authors.lastname: Chi
authors.affiliation: Department of Laboratory.
authors.forename: Denghai
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Laboratory.
authors.forename: Limin
authors.initials: L
authors.lastname: Xu
keywords: acute diarrhea; antibiotics overuse; primary hospitals