PRACTICE GUIDELINES FOR ORDERING STOOL CULTURES IN A PEDIATRIC POPULATION

A comprehensive utilization review was done of all stool culture tests performed at a pediatric hospital during a 3-year period from June 1, 1989 through to July 1, 1992. A total of 4,460 stool culture specimen s were surveyed from 3,420 children. Sixty percent (2,692) of the work -load was from inpatients, 22% (1,001) was from emergency room (ER) vi sits and 18% (767) was from outpatient clinic/office visits. A total o f 9% (294 of 3,420) of the children were confirmed to have enteric bac terial infection, Enteric infections in Southern Alberta follow a typi cal pattern, where most cases of Escherichia coli 0157:H7, Salmonella sp and Campylobacter jejuni are diagnosed in the summer months between June and September. Marked differences were found in the overall stoo l culture positivity rate between hospitalized children (94 of 2,141, 4%), and ambulatory children attending the ER (176 of 892, 19%), Altho ugh a significant number of children had more than one stool culture d one, most cases of enteric bacterial infections were diagnosed on the first stool sample (290 of 294, 98%). Most children (89 of 94, 95%) wh o were hospitalized because of an acute diarrheal illness had a bacter iological diagnosis confirmed within the first 4 days after admission (90 of 94, 96%), including immunocompromised children in the Oncology ward. Over the past year, significant sustainable cost savings have re sulted from the implementation of practice guidelines for ordering ped iatric stool cultures.