Routine Stool Culture Research Articles

A waterborne outbreak in Missouri of Escherichia coli O157:H7 associated with bloody diarrhea and death.

To describe and determine the source of a large outbreak of Escherichia coli O157:H7 (ECO157) infections in Missouri. A case-control study and a household survey. A small city in a rural Missouri township that had an unchlorinated water supply. Case patients were residents of or visitors to Burdine Township with bloody diarrhea or diarrhea and abdominal cramps occurring between 15 December 1989 and 20 January 1990. Escherichia coli O157 was isolated from 21 stool specimens. All isolates were resistant to sulfisoxazole, tetracycline, and streptomycin; produced Shiga-like toxins I and II; and had one 60-megadalton plasmid. Among the 243 case patients, 86 had bloody stools, 32 were hospitalized, 4 died, and 2 had the hemolytic uremic syndrome. In the case-control study, no food was associated with illness, but ill persons had drunk more municipal water than had controls (P = 0.04). The survey showed that, during the peak of the outbreak, bloody diarrhea was 18.2 times more likely to occur in persons living inside the city and using municipal water than in persons living outside the city and using private well water (P = 0.001). Shortly before the peak of the outbreak, 45 water meters were replaced, and two water mains ruptured. The number of new cases declined rapidly after residents were ordered to boil water and after chlorination of the water supply. This was the largest outbreak of ECO157 infections, the first due to a multiply resistant organism, and the first shown to be transmitted by water. System-wide chlorination as well as hyperchlorination during repairs might have prevented this outbreak. Both bloody and nonbloody diarrhea may be common manifestations of this infection, which is probably underdiagnosed because of the failure of routine stool cultures to identify the organism. Cities with deteriorating water systems using untreated water risk widespread illness from contaminated drinking water.

Nosocomial gastrointestinal infections

Clostridium difficile and rotaviruses remain the most common recognized causes of nosocomial diarrhea. Nosocomial diarrhea predisposes to nosocomial infections. Stool softeners and antacids are risk factors associated with C. difficile carriage, while older age, severe underlying disease, antibiotics, gastrointestinal stimulants, stool softeners, and enemas are risk factors related to C. difficile diarrhea. C. difficile-colonized patients may be a source for infections in other hospitalized patients. Vinyl gloves can decrease hand carriage and transmission of C. difficile. Excretion of the organism or cytotoxin may occur even after treatment and clinical response. Nosocomial rotavirus spread in children is related to infected roommates and hospital staff with contaminated hands. Using the proved effective disinfectants and educating staff and parents of the need for and techniques of handwashing are important. Routine stool culture and ova and parasite examination are inappropriate for most patients with nosocomial diarrhea. Helicobacter pylori, Yersinia enterocolitica, Shigella sonnei, and Cryptosporidium parvum are additional etiologies sometimes seen in nosocomial diarrhea. Irrespective of the cause, all hospitalized patients with diarrhea should be promptly placed in enteric precaution to prevent spread of fecal organisms to other hospitalized patients.

Aeromonas HydrophilaDiarrhea

To The Editor:—The recent article published in this Journal by Bloom and Bottone1 requires further clarification and comment. The authors report an outbreak of acute diarrheal illness in a long-term care facility attributed to infection with Aeromonas hydrophila. Only 11 of the 17 patients had stool specimens submitted for bacteriologic analysis, and of those only four of the 11 specimens were positive for A. hydrophila. One patient death was attributed to Aeromonas infection, but it is not clearly stated if this was one of the patients who indeed was positively identified as having been infected with this organism. Routine stool cultures are often insensitive in detecting even common diarrheal pathogens and may lead to a false sense of security that no other offending agent was responsible. It is also important to point out that nosocomial infection with Clostridium difficile2 has been well documented. This is of special concern in nursing home patients who are likely to have received antibiotic therapy either during previous hospitalization or while in the long-term-care facility. C. difficile is frequently transmitted among institutionalized/hospitalized patients and from medical personnel. The present article does not state that laboratory analysis to rule out C. difficile was performed. Further clarification of these items may enhance the validity of the conclusions drawn from this article.

Inappropriate Testing for Diarrheal Diseases in the Hospital

To assess the degree to which routine stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. During a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from the group of patients who had stool specimens submitted after 3 days of hospitalization. Analysis of laboratory work load for a 1-year period showed that specimens from this patient group contributed nearly 50% of the more than 3000 specimens received each year. In contrast, approximately 25% (range, 17% to 33%) of samples, regardless of admission status, were positive for C difficile toxin. Eliminating routine stool cultures and ova and parasite examinations on hospitalized patients would significantly reduce hospital and patient costs without altering patient care. Nationwide, such a policy might achieve a cost savings of +20 to +30 million per year.

Common clinical features as predictors of bacterial diarrhea in infants

Identification of infants with bacterial diarrhea during the first year of life is important to limit potentially serious complications, but indications for stool leukocyte examination and culture are not well defined. The ability of three clinical features-temperature, history of blood in the stool, and stool frequency-to predict the presence of bactrial gastroenteritis was analyzed. Over a 1-year period, 108 (10.4%) bacterial pathogens were isolated from 1,035 infants aged <1 year with diarrhea. Bacterial culture was positive in 14.9% of cases from May to October, compared with 6.2% of cases from November to April. A history of blood in the stool was the best individual predictor with sensitivity of 39%, specificity of 88%, and a positive predictive value of 30%. Temperature >39°C had sensitivity of 34% and specificity of 85%; ≥10 stools in 24 hours had sensitivity of 28% and specificity of 85%. Using combinations of factors, we identified (1) a group of patients at high risk for bacterial diarrhea (infants with two of the three factors studied); (2) a low-risk group (those with temperature ≤38°C, <10 stools in 24 hours, and the absence of blood in the stool); and (3) a group at intermediate risk for bacterial diarrhea (all other patients). We recommend routine stool cultures for infants with a high-risk combination. Additional clinical and laboratory features, such as stool leukocytes, should be studied among patients in the intermediate-risk group.

Usefulness of the stool Wight's stain in the emergency department

A prospective study was conducted to determine if a Wright's stain of stool specimen to detect fecal leukocytes was accurate in predicting the presence of a bacterial pathogen on stool culture. Entry criteria were patient age ≥ 3 months and diarrhea of > 1 day. The patient population was drawn from an urban county hospital emergency department on the Texas-Mexican border. A total of 69 patients were evaluated by both routine stool culture and stool Wright's stain. Twenty-three were evaluated for parasitic pathogens. There were seventeen cultures positive for bacterial pathogens and twenty-three positive Wright's stains. Bacterial isolates included Shigella, Salmonella and Campylobacter. Also detected were Giardia, Shistosoma, Blastocytis and Cryptosporidium. The sensitivity of a Wright's stain positive for fecal leukocytes for the presence of a bacterial pathogen by culture was 82%, with a specificity of 83%. These were significantly correlated with a positive culture for a bacterial pathogen ( P<.01). The predictive value of a positive result was 61%, and predictive value of a negative result was 94%, for bacterial pathogens. The Wright's stain is a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the emergency department.

Remitting Seronegative Symmetrical Synovitis With Pitting Edema

To the Editor.— The article by McCarty et al1described ten elderly patients with an acute-onset seronegative symmetric synovitis associated with pitting of the hands and feet, which completely remitted over several months. The authors believe that these cases were representative of a distinctive syndrome and chose to call it remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome). In their discussion, the authors postulate that an infectious agent might trigger this syndrome in a genetically programmed host. We have recently seen a patient identical to that described by McCarty et al, in whom an infectious agent known to cause a reactive arthritis,Campylobacter jejuni, was isolated by routine stool culture.2 Report of a Case.— On Feb 4, 1985, a 62-year-old man began experiencing a sore throat, nausea, vomiting, an episode of diarrhea, and fever. On the morning of Feb 10, 1985, he awoke

Evaluation and diagnosis of acute infectious diarrhea

The appropriate approach to the diagnosis and management of acute infectious diarrhea is determined by the frequency and setting of the illness, the recognizable causes or syndromes, the cost and yield of available diagnostic tests, and the treatability of the disease. Acute diarrhea affects everyone throughout the world from one to more than six times each year, depending on age, location, and living conditions. The range of identifiable viral, bacterial, and parasitic etiologies is great, and the cost of indiscriminate use of etiologic studies for diagnosis is prohibitive. Because of its insensitivity for many organisms and poor selection of cases for testing, routine stool culture has been one of the most costly and ineffective microbiologic tests; the cost per positive result has traditionally exceeded $900 to $1,000. The appropriate treatment for the vast majority of cases (independent of their cause) is simple and effective: oral glucose- and electrolyte-containing rehydration solution. On the basis of an appropriate history and understanding of pathogenesis, fecal specimens can be selectively obtained and promptly examined for leukocytes and parasites, and the common noninflammatory diarrheas can be separated from the inflammatory infections in order to focus further studies on the latter group. The bacteria for which specific antimicrobial therapy should be considered usually cause Inflammatory diarrhea in the United States. Therefore, only when the history or fecal leukocyte findings indicates an inflammatory process is it appropriate to culture for the routine invasive bacterial pathogens. In sporadic inflammatory diarrhea, culture methods should include those for Campylobacter jejuni as well as Salmonella and Shigella. Several special circumstances may prompt a consideration of parasites (including Giardia, Entamoeba, Strongyloides, Cryptosporidium), Vibrio, Yersinia, Clostridium difficile, enterotoxigenic Escherichia coli, food-borne agents, or sexually transmitted pathogens. The practical value of specific identification of rotaviruses (by enzyme-linked immunosorbent assay, Rotazyme, or electron microscopy) is primarily epidemiologic, particularly In hospitalized infants or young children. Using such a selective approach to fecal culture will greatly increase its yield and can reduce the cost per positive result from $1,000 to less than $150.

Are we Doing the Right Routine Stool Culture: A Prospective Study Among 40 Clinical Laboratories in Karaj City

Implication for health policy/practice/research/medical education: Standard staul culture description. Copyright © 2013, Alborz University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor,

Bacteriologic Studies of Long-Term Convalescent Carriers of Cholera Vibrios.

s1 May 1969Bacteriologic Studies of Long-Term Convalescent Carriers of Cholera Vibrios.Nathanial F. Pierce, M.D., John B. Banwell, D.M., Sherwood I. Gorbach, M.D., Rupak C. Mitra, M.B.B.S.Nathanial F. Pierce, M.D.Search for more papers by this author, John B. Banwell, D.M.Search for more papers by this author, Sherwood I. Gorbach, M.D.Search for more papers by this author, Rupak C. Mitra, M.B.B.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-5-1091_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPatients convalescent from acute bacteriologically proved cholera were studied to determine if any became long-term carriers ofVibrio cholerae. Eighty-one patients in early convalescence were given magnesium sulfate purge after three consecutive daily stool cultures had been negative forV. cholerae. Culture of the liquid stool thus obtained was positive in three patients (3.7%). These three were studied repeatedly for 150 to 404 days to determine the duration and bacteriologic characteristics of the convalescent carrier state. These carriers harbored vibrios from 60 to 331 days. During this period routine stool cultures were usually negative (33 to 36 negative); however, vibrios... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Baltimore, Maryland Calcutta India PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1969Volume 70, Issue 5Page: 1091-1091KeywordsCholeraConvalescenceMagnesiumSulfatesVibrioVibrio cholerae Issue Published: 1 May 1969 PDF DownloadLoading ...