Please always note relevant clinical history, including recent overseas travel.
Parasites -
Send 2 specimens collected on separate days within a 7 day period (some parasites are excreted intermittently) and transport to laboratory within two hours of collection.
Urine, kaolin, magnesia, bismuth, barium, antibiotics, antihelmintics or antiprotozoal substances may interfere with the detection of parasites.
Giardia & cryptosporidium tested by EIA.
Culture -
Cultures for Salmonella, Shigella and Campylobacter are restricted to outpatients and patients hospitalised for less than 72 hours.
Collect one specimen within a 7 day period.
Other bacterial pathogens can also be detected when appropriate clinical history or requests are made.
Fresh specimens are essential - rectal swabs are not suitable.
Viral studies - Rota virus and Adenovirus are routinely tested on patients less than 5 years of age.
Clostridium difficile -
Clostridium difficile testing is recommended on (1st request / on admission):
All patients with hospital-onset diarrhoea (>48 hours after admission)
Patients over 60 years presenting with diarrhoea from the community
Patients with diarrhoea and one or more risk factors including:
exposure to antibiotics
gastric acid suppressive therapy
advanced age (>60 years)
prolonged hospitalization
cancer chemotherapy
immunosuppression.
residence in long-term care facilities such as nursing homes.
It is strongly recommended that all patients with risk factors for C. difficile infection are empirically treated for the condition irrespective of the result of this first test.
Further Clostridium difficile testing(2nd request on the same episode of diarrhoea) will not be performed unless the following criteria are met and specifically stated on the request slip:
1.Diarrhoea not improved after 48 hours of metronidazole or vancomycin (oral form preferred)
AND
2. No other cause of diarrhoea identified (e.g laxatives, bowel preparation, ngt feeds).
§ This testing is not recommended in children under the age of 2 years as asymptomatic carriage is common.
Norovirus
Tested in gastro outbreaks.
Contact Infection control & request using specific request forms.
Store specimens at 4°C.
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