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Application of rejection criteria for stool cultures for bacterial enteric pathogens
K Fan1, A J Morris, L B Reller
1Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Routine stool cultures for enteric pathogens like Salmonella, Shigella, and Campylobacter are low-yield in hospitalized adults and children. Avoid culturing specimens from patients hospitalized longer than three days unless clinically indicated.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Public Health
Background:
- Enteric infections are a significant cause of morbidity.
- Accurate diagnosis of enteric pathogens is crucial for effective treatment and infection control.
- Current guidelines for stool culture indications may lead to unnecessary testing in hospitalized patients.
Purpose of the Study:
- To evaluate the diagnostic yield of stool cultures for Salmonella, Shigella, and Campylobacter spp. in hospitalized adults and children.
- To determine the optimal timing for collecting stool specimens for enteric pathogen detection.
- To assess the utility of clinical factors in predicting positive stool cultures.
Main Methods:
- Prospective study over 20 months assessing stool culture results.
- Specimens analyzed from adult and pediatric patient populations.
- Data collected on duration of hospitalization and clinical indicators.
Main Results:
- Overall pathogen detection rate was low (2.6% in adults, 7.5% in children).
- All positive adult cultures were from patients hospitalized for ≤3 days.
- No significant predictors for enteric pathogens were identified, including stool consistency and fecal leukocytes.
Conclusions:
- Stool cultures for enteric pathogens have a low yield in patients hospitalized for more than three days.
- Routine culturing of stool specimens from prolonged-stay hospitalized patients is not recommended without specific clinical or epidemiological justification.
- This approach can help optimize laboratory resources and reduce unnecessary testing.
Abstract:
Over 20 months, we prospectively assessed the yield of cultures for Salmonella, Shigella, and Campylobacter spp. from adults and children. In the first 10 months, 53% (567 of 1,097) of specimens from adults were from patients who had been in the hospital for > 3 days. Overall, only 2.6% (29 of 1,097) of specimens contained pathogens, and all were from patients who had been in the hospital for < or = 3 days. Over the second 10 months, specimens from adults in the hospital for > 3 days were not cultured unless special reasons existed. Thirty percent (368 of 1,229) of specimens were rejected. Concurrently, 7.5% (51 of 677) of stool specimens from children were positive. Only one positive specimen came from a child who had been in the hospital for > 3 days. Neither stool consistency nor fecal leukocytes were useful predictors for the presence of an enteric pathogen. We recommend that specimens from both adults and children in the hospital for > 3 days not be cultured unless there are delineated plausible clinical or epidemiological reasons to do so.