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[Cost and effectiveness of fecal culture in the etiologic diagnosis of acute diarrhea].

To study the cost-effectiveness of fecal culture in the detection of enteropathogenic or enteroinvasive bacteria, a review and analysis was done of fecal cultures from ambulatory or hospitalized patients treated for acute diarrhea at a Buenos Aires sanatorium during 1985. Of 1,295 fecal cultures performed, pathogens were isolated in 369 cases (28.5%), of which 79 corresponded to Shigella sp. (S. flexnerii, 49; S. sonnei, 29; S. dysenteriae, 2), 25 to Salmonella sp., and 270 to enteropathogenic Escherichia coli (EPEC) of the infant. There was no statistically significant difference between the ambulatory patients and the hospitalized patients in the proportion of positive fecal cultures. The cost of each positive fecal culture was US$ 60.36, while the cost of diagnosing invasion of the mucous membrane (isolation of Shigella sp. or detection of leukocytes in feces) was US$ 109.74. These costs are excessive and could be greatly reduced if the test were applied in only selected cases. Many of the strains of Shigella sp., Salmonella sp., and EPEC that were found were resistant to ampicillin, chloramphenicol, and cotrimoxazole. These cases of resistance suggest that fosfomycin may be one of the antibiotics of choice for the treatment of diarrhea caused by invasive organisms.