American Society for Clinical Pathology
View all recommendations from this societySeptember 4, 2019
Do not routinely test for community gastrointestinal stool pathogens in hospitalized patients who develop diarrhea after day 3 of hospitalization.
A number of studies have indicated that stool culture and parasitological examination is usually not indicated when diarrhea develops more than 3 days after admission to the hospital, because these tests are designed to detect agents of community-acquired gastrointestinal infection (1-3). In contrast, testing for C. difficile should be considered in such patients . In contrast, testing for C. difficile should be considered in such patients, if they are over 2 years in age; patients <2 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.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
1-5: The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel.
6–15: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Choosing Wisely Ad Hoc Committee. This committee is chaired by an ASCP Past President and comprises subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees, and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and
eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs, and a more effective use of our laboratory resources and personnel.
16-35 The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s newly formed Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.
ASCP’s disclosure and conflict of interest policy can be found at www.ascp.org.
Sources
Ramdeen, S. K., & Wortmann, G. W. (2016). What stool testing is appropriate when diarrhea develops in a hospitalized patient?. Cleveland Clinic journal of medicine, 83(12), 882-884.
Morris AJ, Wilson ML, Reller LB (1992). Application of rejection criteria for stool ovum and parasite examinations. J Clin Microbiol 30:3213–3216.
Nikolic D, Richter SS, Asamoto K, Wyllie R, Tuttle R, Procop GW. (2017) Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients. J Clin Microbiol 55:3350-3354.
Bauer TM, Lalvani A, Fehrenbach J, Steffen I, Aponte JJ, Segovia R, Vila J, Philippczik G, SteinbrucknerB, Frei R, Bowler I, Kist M. 2001. Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults. JAMA 285:313–319.doi:10.1001/jama.285.3.313
