Choosing Wisely:

Don’t routinely test for community gastrointestinal stool pathogens in hospitalized patients who develop diarrhea after day 3 of hospitalization.

Rationale and Comments: A number of studies have indicated that stool culture and parasitological examination are usually not indicated when diarrhea develops more than three days after admission to the hospital, because these tests are designed to detect agents of community-acquired gastrointestinal infection. In contrast, testing for C. difficile should be considered in such patients if they are over two years in age; patients less than two years in age commonly have asymptomatic C. difficile colonization. NOTE: There are select patient populations, such as older adults and immunocompromised patients, in whom community-type pathogens may be detected after three days of hospitalization. Therefore, clinicians should be able to obtain stool cultures and/or stool parasitological examinations in these select populations after three days of hospitalization.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Diagnostic accuracy studies
  • Disciplines:
  • Infectious disease
  • Gastroenterologic
  • References: • Ramdeen SK, Wortmann GW. What stool testing is appropriate when diarrhea develops in a hospitalized patient? Cleveland Clinic Journal of Medicine. 2016;83(12):882-884.
    • Morris AJ, Wilson ML, Reller LB. Application of rejection criteria for stool ovum and parasite examinations. J Clin Microbiol. 1992;30:3213-3216.
    • Nikolic D, Richter SS, Asamoto K, Wyllie R, Tuttle R, Procop GW. Implementation of a clinical decision support tool for stool cultures and parasitological studies in hospitalized patients. J Clin Microbiol. 2017;55:3350-3354.
    • Bauer TM, Lalvani A, Fehrenbach J, Steffen I, Aponte JJ, Segovia R, Vila J, Philippczik G, Steinbruckner B, Frei R, Bowler I, Kist M. Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults. JAMA. 2001; 285:313-319.

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