Lab Med Online.  2019 Jan;9(1):22-25. 10.3343/lmo.2019.9.1.22.

Analyzing Patterns for Stool Culture Requests by Physicians to Improve Quality

• Shin H
• Kim S

• KMID: 2430206
• DOI: http://doi.org/10.3343/lmo.2019.9.1.22

Abstract

Although international clinical guidelines generally recommend bacterial stool cultures for patients with acute diarrhea, stool cultures are frequently being requested by physicians regardless of the likelihood of a bacterial infection. This study was conducted to improve the practice of requesting stool cultures by analyzing patterns for stool culture requests by physicians. We retrospectively reviewed 235 stool cultures of patients who visited Gyeongsang National University Hospital from January to February 2017. We analyzed the period of time after which the stool culture was requested after admission, stool characteristics, wet smear, and concomitant tests performed. 38.7% of stool culture requests were made within 3 days of admission. Stool form analysis showed that 36.6% of stools were watery and loose, and 18.8% were firm. Furthermore, >20 leukocytes per high-power field were found only in 0.4% of the wet smears. Among the stool culture requests, 78.7% were prescribed Clostridium difficile culture or toxin tests at the same time. In addition, 13.6% were prescribed diarrhea-causing viral tests as well. Only stool cultures were requested in 10.2% of the cases. Physicians rarely ensure that the adequate criteria are met when requesting for stool cultures. It is necessary to decrease unnecessary diagnostic practices to maintain the quality of care by establishing reliable rejection criteria and the physicians have valid reasons for requesting stool cultures.

Keyword

Stool culture; Quality improvement; Diarrhea; Wet smear; Clostridium difficile

MeSH Terms

Bacterial Infections
Clostridium difficile
Diarrhea
Humans
Leukocytes
Quality Improvement
Retrospective Studies

Reference

1.Fischer Walker CL., Sack D., Black RE. Etiology of diarrhea in older children, adolescents and adults: a systematic review. PLoS Negl Trop Dis. 2010. 4:e768.

2.Shane AL., Mody RK., Crump JA., Tarr PI., Steiner TS., Kotloff K, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017. 65:1963–73.

3.Leber AL. Practical microbiology procedures handbook. 4th ed.Washington, DC: ASMPRESS;2016.

4.Guerrant RL., Kosek M., Lima AA., Lorntz B., Guyatt HL. Updating the DALYs for diarrhoeal disease. Trends Parasitol. 2002. 18:191–3.

5.Guerrant RL., Van Gilder T., Steiner TS., Thielman NM., Slutsker L., Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001. 32:331–51.

6.Meropol SB., Luberti AA., De Jong AR. Yield from stool testing of pediatric inpatients. Arch Pediatr Adolesc Med. 1997. 151:142–5.

7.Rohner P., Pittet D., Pepey B., Nije-Kinge T., Auckenthaler R. Etiological agents of infectious diarrhea: implications for requests for microbial culture. J Clin Microbiol. 1997. 35:1427–32.

8.Chitkara YK. Limited value of routine stool cultures in patients receiv-ing antibiotic therapy. Am J Clin Pathol. 2005. 123:92–5.

9.DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1997. 92:1962–75.

10.Chan SS., Ng KC., Lam PK., Lyon DJ., Cheung WL., Rainer TH. Predictors of positive stool culture in adult patients with acute infectious diarrhea. J Emerg Med. 2002. 23:125–30.

11.Riaz MM., Patel MJ., Khan MS., Anwar MA., Tariq M., Hilal H, et al. Clinical characteristics and predictors of positive stool culture in adult patients with acute gastroenteritis. J Pak Med Assoc. 2012. 62:20–4.

12.Kim YA., Rim JH., Choi MH., Kim H., Lee K. Increase of Clostridium difficile in community; another worrisome burden for public health. Ann Clin Microbiol. 2016. 19:7–12.