Abstract
Background
According to the World Health Organization (WHO), two-thirds of child mortalities are attributable to infectious diseases, with acute gastroenteritis being the second most common cause. The detection of bacterial gastrointestinal pathogens (BGP) through conventional culture (CC) and microscopy is both laborious and time-consuming, particularly in the emergency department (ED) setting. Our study aims to compare CC and real-time PCR (RT-PCR) methods in the detection of BGPs in the pediatric ED and to examine their impact on the use of antibiotics and workflow of the ED
Material and methods
This prospective observational study was conducted at the tertiary academic pediatric ED for three years. Children presenting with acute gastroenteritis suspected to be of bacterial etiology were enrolled in the study. Stool samples were collected from 257 children and studied and analyzed using microscopy, both CC and RT-PCR methods. Real-time PCR and CC detected four major BGP (Salmonella spp., Shigella spp./enteroinvasive Escherichia coli, Campylobacter spp. (jejuni and coli) and Shiga toxin-producing organisms (STEC, Shigella dysenteriae). Demographic characteristics, clinical findings, and, if indicated, blood tests were obtained.
Results
Overall 257 patients were included. The mean age was 4.25 years, and 55.3% were male. The most common complaints were diarrhea (93%), vomiting (53.7%), and fever (53.7%). Enteropathogens were identified in 30.7% and 39.3% of the children by CC and RT-PCR, respectively. The most commonly detected pathogens by both CC and RT-PCR were similar: Campylobacter spp(13%-21%), Salmonella spp(11.3%-14.8%), and Shigella spp.(2.3%-3.1%), respectively. Microscopic stool analyses were positive in 68.4% of children, with WBCs in 41.8% and both WBCs and RBCs in 26.6%. Patients who have positive microscopy are more likely to have positive CC. The mean time to results for CC was 61.9 hours for positive and 40.8 hours for negative cases. RT-PCR results were significantly faster (7.87 hours) than CC (61.9 hours for positive results) (p < 0.001). Blood tests were performed on 123 patients, showing higher mean leukocyte and absolute neutrophil counts in positive PCR cases. Mean CRP was significantly higher in patients with positive results (6.67 mg/dL) than in those with negative results (2.1 mg/dL) (p < 0.001). Only 12.8% of patients were admitted to the ward, with one requiring ICU admission.
Conclusion
Real-time PCR significantly improved the detection rates of bacterial gastrointestinal pathogens, reduced inappropriate antibiotic use, and substantially decreased the time to preliminary results. Additionally, it facilitated the timely discharge of patients from the ED, contributing to shorter hospital stays.