Value of routine stool cultures in hospitalized patients with diarrhea

In a prospective study conducted over a six-month period, the relative yield of 721 routine cultures of stool from adult inpatients as a function of the time after hospital admission was assessed. Salmonella, Campylobacter, Shigella or Yersinia spp. were recovered from 10.9% (41/377) of patients within three days of hospitalization and from only 1.5% (5/344) after three days. However, a review of these patients' charts did not suggest nosocomial transmission but rather a delay in stool collection or asymptomatic carriage. Clostridium difficile was isolated with a high frequency in patients both within and after three days of hospitalization (10.3% and 10.2%, respectively). Thus, stool specimens from adults hospitalized for more than three days should not be cultured except for Clostridium difficile unless there are plausible clinical or epidemiological reasons to do so.