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Related Experiment Videos

Value of stool cultures.

J P Koplan, H V Fineberg, M J Ferraro

    Lancet (London, England)
    |August 23, 1980
    PubMed
    Summary

    Stool cultures rarely identify Salmonella or Shigella, yielding positive results in only 2.4% of cases. Clinical predictors like persistent diarrhea, fever, and abdominal pain with nausea or vomiting are more effective for diagnosing bacterial infections.

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    Area of Science:

    • Clinical microbiology
    • Diagnostic test evaluation
    • Infectious disease epidemiology

    Background:

    • Stool cultures are frequently requested but have a low yield for detecting Salmonella or Shigella.
    • The diagnostic utility of stool cultures in a large teaching hospital setting requires evaluation.
    • Identifying reliable clinical predictors for positive stool cultures is crucial for optimizing test utilization.

    Purpose of the Study:

    • To evaluate the diagnostic yield and clinical predictors of stool cultures in a large teaching hospital.
    • To assess the impact of stool culture results on patient treatment decisions.
    • To propose strategies for improving the appropriate use of stool culture testing.

    Main Methods:

    • Retrospective analysis of 2468 stool culture requests from 1977.
    • Calculation of likelihood ratios for clinical predictors of positive stool cultures.
    • Comparison of culture results with clinical presentation and treatment changes.

    Main Results:

    • Only 58 patients (2.4%) had positive stool cultures for Salmonella or Shigella.
    • Persistent diarrhea, fever, and abdominal pain with nausea or vomiting were strong predictors of positive cultures.
    • Microscopic examination for fecal leukocytes was not a useful predictor.
    • Stool culture results led to appropriate treatment changes in only 10 of 227 patients.

    Conclusions:

    • Stool culture is a low-yield diagnostic test with limited impact on treatment decisions.
    • Clinical prediction rules combining symptoms like persistent diarrhea, fever, and abdominal pain are more effective.
    • Implementing stricter request criteria, including physician signatures and limiting cultures per illness, can improve test utilization.

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