Indications for stool culture to detect enteropathogenic bacteria in adult inpatients:
(1) diarrhea at admission or with onset within 72 hours (<= 3 days) of admission
(2) diarrhea with an onset > 72 hours (> 3 days) after admission only if one or more risk factors present (see below).
(3) presence of a clinical finding consistent with a non-diarrheal manifestation of an enteric infection (see below).
Risk factors justifying stool culture:
(1) age >= 65 years AND one or more serious comorbid conditions resulting in organ dysfunction
(2) HIV infection
(3) neutropenia < 500 per µL
(4) suspected nosocomial outbreak
Non-diarrheal manifestation of an enteric infection:
(1) erythema nodosum
(2) mesenteric lymphadenitis
(3) polyarthritis
(4) fever/pyrexia of unknown origin (FUO/PUO)
If cultures are indicated, then test 3 separate stool samples.
If culture for an enteropathogenic bacteria are not indicated but an infectious diarrhea is suspected, then consider the following:
(1) Clostridium difficile disease
(2) Candida
(3) parasitic infection
(4) viral infection (rotavirus in children)
(5) noninfectious causes
