Culturing practices and antibiotic use in children with diarrhea

To the Editor. — Escherichia coli O157:H7 is a common cause of bloody diarrhea and postdiarrheal hemolytic uremic syndrome (HUS) in the United States.1 However, in many hospital laboratories, a routine stool culture does not include testing for E coli O157:H7.2 Furthermore, some studies suggest that the empiric use of antibiotics in children with E coli O157:H7 infections may increase the risk of HUS.3,4 During a recent investigation of E coli O157:H7 infections and HUS, we reviewed the culturing and antibiotic-prescribing practices at a metropolitan children’s hospital in Texas. We reviewed all emergency department and urgent care records from July 6 to 29, 2000. Of the 2460 records reviewed, 287 (12%) recorded a diagnosis of acute diarrheal illness in a child ≤18 years of age (Fig …