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Validation of the 3-day rule for stool bacterial tests in Japan.
- Source :
-
Internal medicine (Tokyo, Japan) [Intern Med] 2014; Vol. 53 (6), pp. 533-9. - Publication Year :
- 2014
-
Abstract
- Objective: Stool cultures are expensive and time consuming, and the positive rate of enteric pathogens in cases of nosocomial diarrhea is low. The 3-day rule, whereby clinicians order a Clostridium difficile (CD) toxin test rather than a stool culture for inpatients developing diarrhea >3 days after admission, has been well studied in Western countries. The present study sought to validate the 3-day rule in an acute care hospital setting in Japan.<br />Methods: Stool bacterial and CD toxin test results for adult patients hospitalized in an acute care hospital in 2008 were retrospectively analyzed. Specimens collected after an initial positive test were excluded. The positive rate and cost-effectiveness of the tests were compared among three patient groups.<br />Patients: The adult patients were divided into three groups for comparison: outpatients, patients hospitalized for ≤3 days and patients hospitalized for ≥4 days.<br />Results: Over the 12-month period, 1,597 stool cultures were obtained from 992 patients, and 880 CD toxin tests were performed in 529 patients. In the outpatient, inpatient ≤3 days and inpatient ≥4 days groups, the rate of positive stool cultures was 14.2%, 3.6% and 1.3% and that of positive CD toxin tests was 1.9%, 7.1% and 8.5%, respectively. The medical costs required to obtain one positive result were 9,181, 36,075 and 103,600 JPY and 43,200, 11,333 and 9,410 JPY, respectively.<br />Conclusion: The 3-day rule was validated for the first time in a setting other than a Western country. Our results revealed that the "3-day rule" is also useful and cost-effective in Japan.
- Subjects :
- Adult
Aged
Cost-Benefit Analysis
Cross Infection economics
Cross Infection microbiology
Diarrhea epidemiology
Enterocolitis, Pseudomembranous economics
Enterocolitis, Pseudomembranous microbiology
Female
Hospitalization economics
Hospitalization statistics & numerical data
Humans
Inpatients
Japan epidemiology
Male
Middle Aged
Practice Guidelines as Topic
Retrospective Studies
Time Factors
Clostridioides difficile isolation & purification
Cross Infection prevention & control
Diarrhea microbiology
Enterocolitis, Pseudomembranous diagnosis
Feces microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1349-7235
- Volume :
- 53
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Internal medicine (Tokyo, Japan)
- Publication Type :
- Academic Journal
- Accession number :
- 24633021
- Full Text :
- https://doi.org/10.2169/internalmedicine.53.0979