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. 1996 Jul;34(7):1776–1778. doi: 10.1128/jcm.34.7.1776-1778.1996

Contemporary testing for enteric pathogens: the potential for cost, time, and health care savings.

A J Morris 1, P R Murray 1, L B Reller 1
PMCID: PMC229113  PMID: 8784588

Abstract

We sent a questionnaire to 79 clinical microbiology laboratories seeking information on contemporary practices when investigating for bacterial and protozoan enteric pathogens. Data from the 67 respondents (response rate of 85%) showed that a minority of laboratories (40% for stool culture and 45% for ova and parasite [O&P] examinations) had restrictions for testing in place and that fewer laboratories (24% for stool culture and 19% for O&P examinations) rejected specimens from patients who had been in the hospital for > 3 days. Using two estimates, 15 and 40%, for the proportion of all specimens received from patients in the hospital for > 3 days, we calculated savings for the average hospital in this survey. Reagent savings of $4,000 to $10,000 and time savings of 274 to 731 h per year might have been realized. Moreover, between $26,000 and $71,000 in patient charges could have been prevented. On the basis of this survey, wider application of rejection criteria when testing for enteric pathogens appears possible. If implemented, savings to the nation's health care system could be between $27 and $73 million a year.

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Selected References

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  1. Aldeen W. E., Shisenant J., Hale D., Matsen J., Carroll K. Comparison of pooled formalin-preserved fecal specimens with three individual samples for detection of intestinal parasites. J Clin Microbiol. 1993 Jan;31(1):144–145. doi: 10.1128/jcm.31.1.144-145.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bartlett R. C., Mazens-Sullivan M., Tetreault J. Z., Lobel S., Nivard J. Evolving approaches to management of quality in clinical microbiology. Clin Microbiol Rev. 1994 Jan;7(1):55–88. doi: 10.1128/cmr.7.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bowman R. A., Bowman J. M., Arrow S. A., Riley T. V. Selective criteria for the microbiological examination of faecal specimens. J Clin Pathol. 1992 Sep;45(9):838–839. doi: 10.1136/jcp.45.9.838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brady M. T., Pacini D. L., Budde C. T., Connell M. J. Diagnostic studies of nosocomial diarrhea in children: assessing their use and value. Am J Infect Control. 1989 Apr;17(2):77–82. doi: 10.1016/0196-6553(89)90021-7. [DOI] [PubMed] [Google Scholar]
  5. Fan K., Morris A. J., Reller L. B. Application of rejection criteria for stool cultures for bacterial enteric pathogens. J Clin Microbiol. 1993 Aug;31(8):2233–2235. doi: 10.1128/jcm.31.8.2233-2235.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kachoris M., Ruoff K. L., Welch K., Kallas W., Ferraro M. J. Routine culture of stool specimens for Yersinia enterocolitica is not a cost-effective procedure. J Clin Microbiol. 1988 Mar;26(3):582–583. doi: 10.1128/jcm.26.3.582-583.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Koplan J. P., Fineberg H. V., Ferraro M. J., Rosenberg M. L. Value of stool cultures. Lancet. 1980 Aug 23;2(8191):413–416. doi: 10.1016/s0140-6736(80)90453-5. [DOI] [PubMed] [Google Scholar]
  8. Marx C. E., Morris A., Wilson M. L., Reller L. B. Fecal leukocytes in stool specimens submitted for Clostridium difficile toxin assay. Diagn Microbiol Infect Dis. 1993 May-Jun;16(4):313–315. doi: 10.1016/0732-8893(93)90081-h. [DOI] [PubMed] [Google Scholar]
  9. McLaughlin J. C., Rasmussen S. K., Nims L. J., Madar D. A., Yazzie C. R. Evaluation of reliability of pooling stool specimens from different patients and detection of Giardia lamblia antigen by microtiter enzyme-linked immunosorbent assay. J Clin Microbiol. 1993 Oct;31(10):2807–2808. doi: 10.1128/jcm.31.10.2807-2808.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Morris A. J., Wilson M. L., Reller L. B. Application of rejection criteria for stool ovum and parasite examinations. J Clin Microbiol. 1992 Dec;30(12):3213–3216. doi: 10.1128/jcm.30.12.3213-3216.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pappas A. A., Drew M. J., Flick J., Fink L., Fuller G. L., Hough A. J. An introductory orientation to clinical pathology core and on-call responsibilities. Arch Pathol Lab Med. 1994 May;118(5):578–583. [PubMed] [Google Scholar]
  12. Persaud C. A., Eykyn S. J. Stool culture: are you getting value for money? J Clin Pathol. 1994 Sep;47(9):790–792. doi: 10.1136/jcp.47.9.790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Peters C. S., Hernandez L., Sheffield N., Chittom-Swiatlo A. L., Kocka F. E. Cost containment of formalin-preserved stool specimens for ova and parasites from outpatients. J Clin Microbiol. 1988 Aug;26(8):1584–1585. doi: 10.1128/jcm.26.8.1584-1585.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Reller L. B., Mirrett S. Motility-indole-lysine medium for presumptive identification of enteric pathogens of Enterobacteriaceae. J Clin Microbiol. 1975 Sep;2(3):247–252. doi: 10.1128/jcm.2.3.247-252.1975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Robinson A. Rationale for cost-effective laboratory medicine. Clin Microbiol Rev. 1994 Apr;7(2):185–199. doi: 10.1128/cmr.7.2.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rosenblatt J. E., Sloan L. M., Schneider S. K. Evaluation of an enzyme-linked immunosorbent assay for the detection of Giardia lamblia in stool specimens. Diagn Microbiol Infect Dis. 1993 May-Jun;16(4):337–341. doi: 10.1016/0732-8893(93)90086-m. [DOI] [PubMed] [Google Scholar]
  17. Siegel D. L., Edelstein P. H., Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital. JAMA. 1990 Feb 16;263(7):979–982. [PubMed] [Google Scholar]
  18. Telzak E. E., Budnick L. D., Greenberg M. S., Blum S., Shayegani M., Benson C. E., Schultz S. A nosocomial outbreak of Salmonella enteritidis infection due to the consumption of raw eggs. N Engl J Med. 1990 Aug 9;323(6):394–397. doi: 10.1056/NEJM199008093230607. [DOI] [PubMed] [Google Scholar]
  19. Valenstein P., Pfaller M., Yungbluth M. The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch Pathol Lab Med. 1996 Feb;120(2):206–211. [PubMed] [Google Scholar]
  20. Wahlquist S. P., Williams R. M., Bishop H., Addiss D. G., Stewart J. M., Finton R. J., Juranek D. D., Sullivan J. J. Use of pooled formalin-preserved fecal specimens to detect Giardia lamblia. J Clin Microbiol. 1991 Aug;29(8):1725–1726. doi: 10.1128/jcm.29.8.1725-1726.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Yannelli B., Gurevich I., Schoch P. E., Cunha B. A. Yield of stool cultures, ova and parasite tests, and Clostridium difficile determinations in nosocomial diarrheas. Am J Infect Control. 1988 Dec;16(6):246–249. doi: 10.1016/s0196-6553(88)80003-8. [DOI] [PubMed] [Google Scholar]

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