Derivation and Validation of Guidelines for Stool Cultures for Enteropathogenic Bacteria Other Than &lt;EMPH TYPE="ITAL"&gt;Clostridium difficile&lt;/EMPH&gt; in Hospitalized Adults

Bauer, Tilman; Lalvani, Ajit; J, Fehrenbach; Steffen, Ingrid; Aponte, John J.; Segovia, Roberto; Vila, Jordi; Philippczik, Gabi; Steinbrückner, Bernhard; Frei, Reno; Bowler, I.C.J.W.; Kist, Manfred

doi:10.1001/jama.285.3.313

Cited by 103 publications

(90 citation statements)

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“…The 3-day rule is derived from the small number of faecal pathogens isolated from patients who have been hospitalized for longer than 3 days (Bauer et al, 2001;Wood, 2001). It suggests that faecal samples from these patients should not be processed except under certain circumstances but does not take into account the relatively lengthy incubation period for Cryptosporidium.…”

Section: Resultsmentioning

confidence: 99%

An audit of the laboratory diagnosis of cryptosporidiosis in England and Wales

Chalmers

Atchison

Barlow

et al. 2015

Journal of Medical Microbiology

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To assess the level of practice consistent with UK national standards for Cryptosporidium testing, an audit was performed of 156 publicly funded clinical microbiology laboratories in England and Wales between August 2013 and April 2014. Responses were received from 85 (54 %) laboratories. First line diagnostic methods used were mainly microscopy with modified Ziehl-Neelsen (mZN) or auramine phenol (AP) staining (68/85, 80 %), enzyme immunoassays (EIAs) (16/85, 19 %) or in-house PCR (1/85, 1 %). The use of EIAs was more widespread than reported previously. Various methods were used for confirmation of positive EIA reactions and laboratories frequently resorted to sending samples to the national reference laboratory for this purpose, indicating that guidance is required for performance monitoring and confirmation of positive reactions. Laboratory positivity rates were related to the diagnostic test used, with highest median rates reported by those using PCR, EIAs or AP microscopy, and the lowest by those using mZN microscopy. One-third of responding laboratories (28/85, 33 %) routinely tested all stools for Cryptosporidium. However, 16 (19 %) laboratories used stool consistency to decide whether to test for this parasite. Other selection criteria included patient age (n518; 21 % laboratories), history or clinical details (n540; 47 %), duration of hospitalization (n518; 21 %) or clinician requests (n525; 29 %). To encourage laboratories to test all stools submitted for the investigation of diarrhoeal illness for Cryptosporidium, revision of the guidance in the national standards is under way. This will enable improved assessment of the burden of illness and ability to monitor outbreaks, and measure changes in reported cases.

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Section: Resultsmentioning

confidence: 99%

An audit of the laboratory diagnosis of cryptosporidiosis in England and Wales

Chalmers

Atchison

Barlow

et al. 2015

Journal of Medical Microbiology

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“…26,27 In this study, the diarrhea samples were collected from immunocompromised hosts who were hospitalized due to acute diarrhea as a main complaint.…”

Section: Discussionmentioning

confidence: 99%

The clinical features and infectious etiologies of acute diarrhea in immunocompromised hosts

Lee

Kim

Kim³

et al. 2017

KMJ

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Objectives The acute diarrhea is a common complaint among immunocompromised hosts, and may cause life threatening event. The infectious etiologies vary depending on virus, bacteria, and parasites. The most common etiology of acute gastroenteritis is known as enteric virus in Korea. But there are few studies about the infectious etiology of acute gastroenteritis in immunocompromised hosts. The aim of this study was to investigate the infectious etiologies of acute diarrhea in immunocompromised hosts. Methods Seventy three patients were enrolled prospectively in a university hospital from January 2013 to July 2014. Immunocompromised hosts included above 65-year-old people, patients with chronic diseases, solid organ or stem cell transplants, solid organ malignancies, hematologic malignancies, immunosuppressive or steroid taking patients. The clinical data were collected and stool samples collected during diarrhea were undergone laboratory analysis for enteric viruses and bacterial enteropathogens including Salmonella spp., Shigella spp., and Clostridium difficile. Results Fifty five patients were analyzed as follows : above 65 year-old people were 36 cases (66%), previous antibiotic usage was 22 cases (41.5%). 44 cases (81.1%) were admitted to general ward whereas 9 cases to ICU (17%). 41 cases (73.6%) were treated with antibiotics. Positive C. difficile toxin assays were 6 cases (11.9%). Other infectious etiologies were not found. Conclusions C. difficile infection was more common infectious etiology while enteric viruses and other bacteria are not associated with acute diarrhea among immunocompromised hosts in this study. So C. difficile infection must be considered preferentially in immunocompromised hosts with acute diarrhea.

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“…Creemos que más importante que implementar criterios de rechazo, es difundir en el ámbito médico la correcta selección de los pacientes que, estando hospitalizados, requieran CP 14 , como son los pacientes inmunocomprometidos, los con edad superior a 65 años y comorbilidad, pacientes infectados por VIH y en los casos de brotes epidémicos intrahospitalarios 7 .…”

Section: Discussionunclassified

Evaluación del rendimiento del coprocultivo en pacientes hospitalizados

et al. 2005

Rev. chil. infectol.

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Several studies have concluded that it is inappropriate to perform stool cultures (SC) to inpatients that have stayed hospitalized three days or more because nosocomial diarrhea is not due to enteric pathogenic bacteria that are searched through this exam. The aim of this paper was to analyze the SC yield performed to patients hospitalized in the UC Health Net since January to December 2002 and the rate of positive results obtained depending on the length of hospitalization in order to define if international guidelines are useful to the national reality. During twelve months 3474 SC were evaluated, 458 (13.2%) belonged to inpatients. Of them 16 (3.5%) were positive, 13 were obtained on the first day, 2 at the second day and 1 at the fifth day of hospitalization. Only 1/190 (0.5) SC obtained after two days of hospitalization yielded a positive result. These results reinforce the international recommendation of not performing SC to inpatients that have stayed more than three days at the hospital; besides, considering previous figures, we suggest to make a cutoff at day two of hospitalization, after two days there is no a significant clinical impact. This strategy means to reduce 41% of these analyses and to save the corresponding money.Key words: Stool culture; Nosocomial diarrhea; Enteric pathogenic bacteria. Palabras clave: Coprocultivo, diarrea nosocomial, enteropatógenos. IntroducciónEl síndrome diarreico agudo es una causa muy frecuente de consulta y hospitalización, sobre todo en niños. Generalmente la causa de estos cuadros se ha asociado a malas condiciones de higiene o a una inadecuada preparación y conservación de los alimentos. Sin embargo, en pacientes hospitalizados la diarrea generalmente es producida por otras causas. Se ha visto que en lactantes, entre 20 y 50% de las diarreas nosocomiales pueden ser causadas por rotavirus o astrovirus 4 . Escherichia coli enteropatógena puede ser causa de brotes intrahospitalarios por su alta transmisibilidad; sin embargo, se recomienda su búsqueda sólo en brotes epidémicos. 5Clostridium difficile, también es un agente causal de gran importancia en diarrea nosocomial. La prevalencia de este último en muestras de pacientes hospitalizados con diarrea puede llegar hasta 10% 6 . En cuanto a las bacterias enteropatógenas que habitualmente se buscan en el coprocultivo (CP), la tasa de positividad de las muestras obtenidas de pacientes que llevan menos de tres días hospitalizados puede ser de hasta 12%; sin embargo, esta cifra disminuye a 1,4% en pacientes que llevan tres días o más hospitalizados 7 , siendo este último grupo de pacientes el que contribuye hasta en 50% del total de CP realizados 1 . Dado que el CP es un examen laborioso y de alto costo, es necesario racionalizar su indicación, seleccionando los pacientes que clínicamente o por situación epidemiológica lo ameriten. Habi-

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Derivation and Validation of Guidelines for Stool Cultures for Enteropathogenic Bacteria Other Than <EMPH TYPE="ITAL">Clostridium difficile</EMPH> in Hospitalized Adults

Abstract: Our modified 3-day rule for use in selecting cases for stool culture is sensitive to sporadic and epidemic cases of nosocomial diarrhea in hospitalized adults.

Cited by 103 publications

References 29 publications

An audit of the laboratory diagnosis of cryptosporidiosis in England and Wales

An audit of the laboratory diagnosis of cryptosporidiosis in England and Wales

The clinical features and infectious etiologies of acute diarrhea in immunocompromised hosts

Evaluación del rendimiento del coprocultivo en pacientes hospitalizados

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