BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for inte...BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.METHODS Overall,400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital(January 2016 to December 2018).Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella,Campylobacter,Shigella,Escherichia coli O157:H7,Aeromonas,Vibrio,and Clostridium difficile.We reviewed clinical and laboratory findings using stool multiplex PCR.RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture(49.2%vs 5.2%),with Campylobacter as the most common pathogen(54%).Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR(1124.5±816.9 mg/kg vs 609±713.2 mg/kg,P=0.001).C-reactive protein(OR=1.01,95%CI:1.001-1.027,P=0.034)and sigmoidoscopy-detected colitis(OR=4.76,95%CI:1.101-20.551,P=0.037)were independent factors in stool PCR-based detection of bacterial pathogens.Sensitivity and specificity of calprotectin were evaluated to be 70.5%and 60.9%,respectively(adjusted cut-off value=388 mg/kg).CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture,and it is correlated with calprotectin expression.Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.展开更多
Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate ...Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.展开更多
The pathogens and opinion for antibiotic treatment in adult patients with 1-14 fecal white blood cells per high power field （WBC/HPF） of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. St...The pathogens and opinion for antibiotic treatment in adult patients with 1-14 fecal white blood cells per high power field （WBC/HPF） of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. Stool specimens of adult patients with acute non-bloody diarrhea and stool examination showing 1-14 fecal WBC/HPF were collected for bacterial culture and viral detection. Patients included in this study were 196 cases with mean age of （37.9±17.4） years and 42.3% was women. The bacterial and viral detection rates were 63 （32.1%） and 21 （10.7%）, respectively. Of the isolated pathogens, campylobacteria was present in 14 （22.0%） samples and was the most common bacteria and calicivirus was found in 10 （47.6%） samples and was the most common virus. Based on single pathogens, 46 cases were caused by invasive pathogens, 26 cases were caused by non-invasive pathogens. The body temperature was significantly higher in feverish patients caused by invasive pathogens than those caused by non-invasive pathogens （（38.44-0.7） ℃ vs （37.74-0.4） ℃, P = 0.002）. The probability of diarrhea caused by invasive pathogens was higher in patients with T〉38.4℃ than those with T_〈38.4℃ （RR = 1.5）. When T〉38.4℃ is used as the threshold for antibiotic treatment, the misuse rate of antibiotics would decrease from 26.9% to 3.8% （P = 0.021）. So T〉38.4 ℃ may be used as a possible reference value for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea.展开更多
文摘BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.METHODS Overall,400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital(January 2016 to December 2018).Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella,Campylobacter,Shigella,Escherichia coli O157:H7,Aeromonas,Vibrio,and Clostridium difficile.We reviewed clinical and laboratory findings using stool multiplex PCR.RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture(49.2%vs 5.2%),with Campylobacter as the most common pathogen(54%).Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR(1124.5±816.9 mg/kg vs 609±713.2 mg/kg,P=0.001).C-reactive protein(OR=1.01,95%CI:1.001-1.027,P=0.034)and sigmoidoscopy-detected colitis(OR=4.76,95%CI:1.101-20.551,P=0.037)were independent factors in stool PCR-based detection of bacterial pathogens.Sensitivity and specificity of calprotectin were evaluated to be 70.5%and 60.9%,respectively(adjusted cut-off value=388 mg/kg).CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture,and it is correlated with calprotectin expression.Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.
基金This work was Funded by National"863"Program (Grant No.2006AA020703)Beijing Key Project(Grant No. D0206010041091)
文摘Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.
基金Major National Science and Technology Projects(Grant No.2013ZX10004605,2013ZX10004605001004)
文摘The pathogens and opinion for antibiotic treatment in adult patients with 1-14 fecal white blood cells per high power field （WBC/HPF） of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. Stool specimens of adult patients with acute non-bloody diarrhea and stool examination showing 1-14 fecal WBC/HPF were collected for bacterial culture and viral detection. Patients included in this study were 196 cases with mean age of （37.9±17.4） years and 42.3% was women. The bacterial and viral detection rates were 63 （32.1%） and 21 （10.7%）, respectively. Of the isolated pathogens, campylobacteria was present in 14 （22.0%） samples and was the most common bacteria and calicivirus was found in 10 （47.6%） samples and was the most common virus. Based on single pathogens, 46 cases were caused by invasive pathogens, 26 cases were caused by non-invasive pathogens. The body temperature was significantly higher in feverish patients caused by invasive pathogens than those caused by non-invasive pathogens （（38.44-0.7） ℃ vs （37.74-0.4） ℃, P = 0.002）. The probability of diarrhea caused by invasive pathogens was higher in patients with T〉38.4℃ than those with T_〈38.4℃ （RR = 1.5）. When T〉38.4℃ is used as the threshold for antibiotic treatment, the misuse rate of antibiotics would decrease from 26.9% to 3.8% （P = 0.021）. So T〉38.4 ℃ may be used as a possible reference value for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea.
