K.LEE1, A.HAN1, DR DEEPAK R.N1, CHAI.S.T1, LAGMAN.A.C1, BHAWANI1, LAM.R.L1, SIM.S.L1, KALAEYVAANIE1, CHIN P.Y1, NG.Y.X1, TEO.C.J1
Khoo Teck Puat Hospital1
The College of American Pathologists (CAP) recommends that stool cultures for community-enteric pathogens (excluding C. difficile testing) should not be performed in patients hospitalised for more than three days without special indications. The aim of this study was to assess whether our yield would go up significantly without this restriction.
Between July 1, 2020 and March 18, 2021, we accepted (without rejection based on hospitalisation duration) all inpatient stool specimens sent to the Khoo Teck Puat Hospital (KTPH) microbiology laboratory for enteric pathogen culture. We considered a stool culture positive for enteric pathogens when it grew Salmonella spp., Shigella spp., Vibrio spp. or Campylobacter spp.
During the study period, 74/540 inpatient stool cultures (12.9%) had been ordered after the third day of hospitalisation. Out of 74 stool cultures, 5 stool cultures (from 4 unique patients) grew pathogen [Campylobacter jejuni, n=2 (isolated from same patient), Salmonella species, n=1, Vibrio fluvialis, n=2)].
In our hospital, the yield of stool cultures from patients with more than 3 days hospitalisation was 6.8% (5/74) with one repeatedly positive patient. We have elected to prioritise yield and made this standard practice. During our last CAP inspection, this has been accepted as a valid exception. We hope this may encourage other laboratories to examine their acceptance and rejection criteria.