Stool cultures for Campylobacter, Salmonella and Shigella and/or Yersinia spp. are frequently ordered in critically ill patients with diarrhea. The aim of this study is to analyze the diagnostic yield in a large cohort of critically ill patients. Therefore, we performed a cohort study at the Department of Intensive Care Medicine of a University Hospital (11 ICUs).
From all patients who were admitted to the ICU between 2010 and 2015, stool cultures were taken from 2.189/36.477 (6%) patients due to diarrhea. Results of all stool cultures tested for Campylobacter, Salmonella and Shigella and/or Yersinia spp. were analyzed. Overall, 5.747 tests were performed; only six were positive (0.1%). In four of these, Campylobacter spp. were detected; diarrhea started within 48 h after ICU admission. Two patients with Salmonella spp. detection were chronic shedders. On the contrary, testing for Clostridium difficile via GDH- and toxin A/B-EIA yielded positive results in 179/2209 (8.1%) tests and revealed 144/2.189 (6.6%) patients with clinically relevant C. difficile infection.
Stool testing for enteric pathogens other than C. difficile should be avoided in ICU patients and is only reasonable when diarrhea commenced less than 48 h after hospital admission.
Manthey CF, Eckmann L, Fuhrmann V. Therapy for Clostridium difficile infection—any news beyond Metronidazole and Vancomycin? Exp Rev Clin Pharmacol. 2017;10:1–12. CrossRef
Deshpande A, Pasupuleti V, Patel P, et al. Repeat stool testing to diagnose Clostridium difficile infection using enzyme immunoassay does not increase diagnostic yield. Clin Gastroenterol Hepatol. 2011;9:665-9e1. CrossRef
Mauch HPA, Herrmann M, Kniehl E, Kist M. MIQ 09: Gastrointestinale Infektionen Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik. Amsterdam: Urban & Fischer Verlag/Elsevier GmbH; 2013.
Valenstein P, Pfaller M, Yungbluth M. The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch Pathol Lab Med. 1996;120:206–11. PubMed
- Stool cultures at the ICU: get rid of it!
Carolin F. Manthey
Ansgar W. Lohse
- Springer International Publishing
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