Prospective study on the overuse of blood test-guided antibiotics on patients with acute diarrhea in primary hospitals of China

Figures & data

Figure 1 Baseline laboratory results for the study cohort.

Notes: (A) The percentage of neutrophils in blood work tests of each group. (B) The number of WBC in each group. (C) The value of CRP in each group. Infection groups were classified by microbiological culture examination. Combination group means both bacteria and virus were detected. **P<0.01.
Abbreviations: CRP, C-reactive protein; Neu%, percentage of neutrophils; WBC, white blood cells.

Table 1 Characteristics of patients in different infection groups

Variables	Infection groups (total n=330)				Overall P-value
	Negative (n=168)	Bacteria (n=68)	Virus (n=85)	Combination (n=9)
Male, %	82, 48.8%	35, 51.5%	45, 52.9%	6, 66.7%	0.720
Age, years	43.88±17.86	42.46±17.26	45.13±16.44	44.56±24.28	0.828
Vomiting, %	38, 22.6%	17, 25.0%	32, 37.6%	3, 33.3%	0.079
Stomachache, %	82, 48.8%	37, 54.4%	40, 47.1%	4, 44.4%	0.806
Fever, %	22, 13.1%	23, 33.8%	15, 17.6%	0, 0.0%	0.001**
CRP (mg/L)	11.31±24.41	12.70±20.40	11.94±14.24	5.97±10.20	0.869
WBC (10^9/L)	8.84±3.32	11.12±4.44	8.98±3.02	10.00±3.86	0.000**
Neu%	73.57±12.84	80.28±8.78	76.76±14.27	78.91±12.65	0.002**
Symptom duration (h)	17±8	13±8	15±7	15±8	0.124
Diarrhea (number of times)	6.21±4.07	5.99±2.50	6.81±3.84	6.00±2.55	0.519

Notes: Infection groups were classified by microbiological culture examination. Combination group includes patients with both bacteria and virus detected. P, Pearson’s chi-square test. Data presented as n % or mean ± standard deviation.

** P<0.01.

Abbreviations: CRP, C-reactive protein; Neu%, percentage of neutrophils; WBC, white blood cells.

Table 2 Blood test results in different infection groups

Grading group	N (%) in each infection group
	Negative	Bacteria	Virus	Combination	Total
0	69 (66.3)	12 (11.5)	20 (19.2)	3 (2.9)	104
1	40 (42.6)	20 (21.3)	31 (33.0)	3 (3.2)	94
2	46 (48.4)	24 (25.3)	23 (24.2)	2 (2.1)	95
3	13 (35.1)	12 (32.4)	11 (29.7)	1 (2.7)	37

Note: Grading groups were classified by the total number of positive results in tests of CPR, WBC, and Neu%.

Abbreviations: CRP, C-reactive protein; Neu%, percentage of neutrophils; WBC, white blood cells.

Table 3 Antibiotic use rate in each infection group

Grading group	N (%) of antibiotic use			Ratio (non-bacterial use/bacterial use)
	Non-bacterial infection (overuse)	Bacterial infection (proper use)	Total
0	26 (81.3)	6 (18.8)	32	4.3
1	54 (71.1)	22 (28.9)	76	2.5
2	63 (72.4)	24 (27.6)	87	2.6
3	24 (64.9)	13 (35.1)	37	1.8
Overall	167 (72.0)	65 (28.0)	232	2.6

Notes: Non-bacterial infection includes negative and virus groups; bacterial infection includes bacteria and combination groups. Antibiotic use in non-bacterial infection group is considered as misuse of antibiotics.

Table S1 Primer sequences for bacteria identification

Gene name (bacteria type)	Primers (5′–3′)	Production length (bp)
invA (Salmonella)	F: AGG TGA CAC TAT AGA ATA	323
	R: GTA CGA CTC ACT ATA GGG A
ipaH (Shigella and EIEC)	F: GTT CCT TGA CCG CCT TTC CGA TAC CGT C	619
	R: GCC GGT CAG CCA CCC TCT GAG AGT AC
stx1 (EHEC)	F: AAA TCG CCA TTC GTT GAC TAC TTC T	370
	R: TGC CAT TCT GGC AAC TCG CGA TGC A
stx2 (EHEC)	F: CAG TCG TCA CTC ACT GGT TTC ATC AC	283
	R: GGA TAT TCT CCC CAC TCT GAC ACC
eaeA (EHEC and EPEC)	F: TCA ATG CAG TTC CGT TAT CAG TT	482
	R: GTA AAG TCC GTT ACC CCA ACC TG
aggR (EAEC)	F: CTA TAC ACA AAA GAA CCA AGC	254
	R: ACA GAA TCG TCA GCA TCA GC
lt (ETEC)	F: TCT CTA TGT GCA TAC GGA GC	322
	R: CCA TAC TGA TTG CCG CAA
mapA (Campylobacter jejuni)	F: AGG TGA CAC TAT AGA ATA	627
	R: GTA CGA CTC ACT ATA GGG A

Table S2 Primer sequences for virus identification

Virus type	Primers and probes	Sequence
Rotavirus	NVP3-F	ACCATCTTCACRTRACCCTC
	NVP3-R	GGTCACATAACGCCCC
	NVP3-Probe	ATGAGCACAATAGTTAAAAGCTAACACTGTCAA
Adenovirus	Adeno-F	GCCACGGTGGGGTTTCTAAACTT
	Adeno-R	GCCCCAGTGGTCTTACATGCACATC
	Adeno-Probe	TGCACCAGACCCGGGCTCAGGTACTCCGA
Astrovirus	AV1	CCGAGTAGGATCGAGGGT
	AV2	GCTTCTGATTAAATCAATTTTAA
	Avs	CTTTTCTGTCTCTGTTTAGATTATTTTAATCACC
Sapovirus	SV1	GCTGTTTCTACTGGTGCA
	SV2	GGCATCCTGTCTTTCCAAGCA
	SVP	CCAATCTAATGTCCCTGAGGCAATACGTAA
Norovirus	COG1F	CGTTGGATGCGCTTTCATGA
	COG1R Probe	CTTAGACGCCATCATCATTTAC
	RING1-TP	AGATTGCGATCTCCTGTCCA
Vibrio	TLHF	AGGTGACACTATAGAATA
	TLHR Probe	GTACGACTCACTATAGGGA

Table S3 The polymerase chain reaction condition of diarrhea pathogens

Pathogen type	Temperature (°C)	Time	Cycles
Bacteria and Vibrio	50	30 min
	95	15 min
	90	30 s	10
	56	30 s
	72	60 s
	90	30 s	10
	68	30 s
	72	60 s
	90	30 s	20
	50	30 s
	72	60 s
	72	3 min
Rotavirus	50	30 min	45
	95	15 min
	95	15 s
	60	1 min
	50	45 min
Astrovirus	95	15 min	45
	94	15 s
	55	1 min
Sapovirus	50	30 min	40
	95	15 min
	94	15 s
	55	34 s
Norovirus	50	30 min	45
	95	15 min
	95	10 s
	60	1 min
Adenovirus	95	15 min	45
	95	15 s
	60	1 min