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Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness.

Abstract We aimed to investigate the diagnostic yield of stool cultures and identify predictive factors for positive cultures in patients with diarrheal illness.A total of 13,327 patients who underwent stool cultures due to diarrheal illness were reviewed. Stool cultures were performed for enteric pathogens, including Salmonella, Shigella, Vibrio, Klebsiella oxytoca, and Yersinia. The culture-positive group was compared with the culture-negative group who were randomly selected from culture negative patients.A total of 196 patients (1.47%) were diagnosed with positive stool culture. In 196 culture positive patients, Salmonella spp. (75.0%) was detected most commonly, followed by Vibrio (19.4%). Univariate analyses showed fever (>37.8°C), vomiting, duration and frequency of diarrhea, and high C-reactive protein (CRP) were significantly associated with positive stool culture. Multivariate analysis showed fever (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.25-4.35; P = .008), ≥5/day of diarrhea (OR, 3.52; 95% CI, 1.93-6.44; P < .001) and >50 mg/L of CRP (OR, 2.27; 95% CI, 1.18-4.36; P = .014) were independent predictors for positive stool culture. OR in patients with all 3 factors was 6.55 (95% CI, 2.56-16.75; P < .001). Vomiting (OR, 0.32; 95% CI, 0.17-0.57; P < .001) was a negative predictive factor.Diagnostic yield of stool culture in patients with diarrheal illness is very low. Fever, frequency of diarrhea, and high CRP are predictors for positive stool cultures. These findings may lead to more discerning and cost-effective utilization of stool culture by clinicians.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28746227
OWN - NLM
STAT- MEDLINE
DA  - 20170726
DCOM- 20170807
LR  - 20170807
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 30
DP  - 2017 Jul
TI  - Diagnostic yield of stool culture and predictive factors for positive culture in 
      patients with diarrheal illness.
PG  - e7641
LID - 10.1097/MD.0000000000007641 [doi]
AB  - We aimed to investigate the diagnostic yield of stool cultures and identify
      predictive factors for positive cultures in patients with diarrheal illness.A
      total of 13,327 patients who underwent stool cultures due to diarrheal illness
      were reviewed. Stool cultures were performed for enteric pathogens, including
      Salmonella, Shigella, Vibrio, Klebsiella oxytoca, and Yersinia. The
      culture-positive group was compared with the culture-negative group who were
      randomly selected from culture negative patients.A total of 196 patients (1.47%) 
      were diagnosed with positive stool culture. In 196 culture positive patients,
      Salmonella spp. (75.0%) was detected most commonly, followed by Vibrio (19.4%).
      Univariate analyses showed fever (&gt;37.8 degrees C), vomiting, duration and
      frequency of diarrhea, and high C-reactive protein (CRP) were significantly
      associated with positive stool culture. Multivariate analysis showed fever (odds 
      ratio [OR], 2.33; 95% confidence interval [CI], 1.25-4.35; P = .008), &gt;/=5/day of
      diarrhea (OR, 3.52; 95% CI, 1.93-6.44; P &lt; .001) and &gt;50 mg/L of CRP (OR, 2.27;
      95% CI, 1.18-4.36; P = .014) were independent predictors for positive stool
      culture. OR in patients with all 3 factors was 6.55 (95% CI, 2.56-16.75; P &lt;
      .001). Vomiting (OR, 0.32; 95% CI, 0.17-0.57; P &lt; .001) was a negative predictive
      factor.Diagnostic yield of stool culture in patients with diarrheal illness is
      very low. Fever, frequency of diarrhea, and high CRP are predictors for positive 
      stool cultures. These findings may lead to more discerning and cost-effective
      utilization of stool culture by clinicians.
FAU - Lee, Jae Young
AU  - Lee JY
AD  - aDepartment of Internal Medicine, Chung-Ang University College of Medicine
      bDivision of Infectious Diseases, Department of Internal Medicine, Samsung
      Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
      Korea.
FAU - Cho, Sun Young
AU  - Cho SY
FAU - Hwang, Hannah Sun Hae
AU  - Hwang HSH
FAU - Ryu, Ja Young
AU  - Ryu JY
FAU - Lee, Jongjin
AU  - Lee J
FAU - Song, In Do
AU  - Song ID
FAU - Kim, Beom Jin
AU  - Kim BJ
FAU - Kim, Jeong Wook
AU  - Kim JW
FAU - Chang, Sae Kyung
AU  - Chang SK
FAU - Choi, Chang Hwan
AU  - Choi CH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - Diarrhea/economics/*microbiology
MH  - Feces/*microbiology
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Logistic Models
MH  - Male
MH  - Microbiological Techniques/economics
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Prognosis
MH  - Republic of Korea
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2017/07/27 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/07/27 06:00
AID - 10.1097/MD.0000000000007641 [doi]
AID - 00005792-201707280-00058 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(30):e7641. doi: 10.1097/MD.0000000000007641.