| Test: | Stool Culture Order in NUlirt or complete NPHL Test Order Form |
| Synonym: | Enteric Pathogens Culture, Routine Stool, Feces Culture |
| Method: | Standard culture for Salmonella, Shigella, and Campylobacter and qualitative Enzyme Immunoassay for Shiga-like toxin (Hemorrhagic E. coli) |
| Availability: | Daily, final report at 3d for negatives. Positives are reported as soon as detected. |
| Specimen: | Stool |
| Collection Device: | Collect stool in a clean dry container or NPHL Stool collection kit (available at Client Services). IMMEDIATELY transfer sufficient stool to Para-Pak Enteric Plus Transport vial to bring the liquid level to the 'Fill' line or approximately 5 ml of stool sample. Tighten the cap and shake firmly to insure that the specimen is mixed. Rectal swab can be used in infants; fecal material must be present on swab. Specimen Labeling: Test subject to CLIA regulations and requires 2 patient identifiers and specimen source on container. |
| Volume: | 10mL stool in transport maintenance media |
| Storage/Transport: | Prior to and during shipment: Ambient 15-25°C |
| Unacceptable: | Non-sterile or leaking container, multiple specimens (more than 1 in a 24h period), Stool received during a colonoscopy. Unpreserved stool will be rejected if greater than 1h old. Enteric Plus inoculated with stool older than 96 hours or greater than 4d. Frozen stool. Stool contaminated with urine, barium, bismuth, mineral oil, water or other contaminants are unacceptable. Extremely 'hard' formed stools are unacceptable. Do not use the vial if beyond expiration date or contents of the vial are cloudy or yellow. |
| Specimen Stability: | Ambient for 96h (2d) or 2-8°C or 4d |
| Reference Interval: | Negative for Salmonella, Shigella and Shiga-like toxin-producing E.coli. |
| Reportable Disease: | Report positive Salmonella, Shigella, Campylobacter or Shiga-Toxin producing E.coli within 7d to local or state health department. Refer to Nebraska DHHS Title 173, Communicable Diseases. Ship all Salmonella, Shigella and Shiga-Toxin producing E.coli isolates to NPHL. |
| Comments: | Pre-approval needed from state or local health department. Send approval to NPHL@unmc.edu or call (402) 559-9444. Preferred test for suspected bacterial diarrhea evaluation. Testing includes cultures for Salmonella, Shigella, Campylobacter, E. coli O157, and EIA for Shiga-like toxin from E. coli. Can be used to rule out Aeromonas and Plesiomonas; specify the pathogen to rule out. When collecting a stool from an infant with diarrhea, place two disposable diapers, absorbent side to absorbent side, on the child. IMMEDIATELY transfer sufficient stool to Para-Pak Enteric Plus Transport vial to bring the liquid level to the 'Fill' line or approximately 5 ml of stool sample. The Shiga-like toxin EIA portion of this test will identify the presence of shigatoxin-positive E. coli in stool; however, it cannot determine the specific strain of E. coli (e.g. E. coli O157:H7 or non-O157). The Shiga-like toxin EIA (SHIGA) test can be ordered as a single test in cases for proof-of-cure testing following a primary diagnosis of enterohemorrhagic E.coli-caused infection in an outbreak OR where a screen for the primary detection of a Shiga-like toxin-producing E. coli is requested. All shigatoxin positive stools (in enteric transport media or plate isolate) should be sent to the NPHL for isolation of the shigatoxin positive E. coli for whole genome sequencing. Stool specimens can be sent as a Category B, biological substance. All shigatoxin positive isolates must be shipped as Category A, Infectious Substance. Order as E. coli (Hemorrhagic) Culture, Stool, HECCU. Routine stool cultures are not recommended from patients hospitalized for >3d, unless the patient is known to be HIV positive or the request has been approved by the NPHL Director. NUlirt packing list or NPHL Test Order Form (completed in entirety) must accompany the specimen. All shigatoxin positive stools (preserved in enteric transport media, Cary-Blair media) should be sent to the NPHL for isolation of the shigatoxin positive E. coli for DNA fingerprinting (PFGE) and if not already determined, for serotyping (send as a Category B specimen). Order as E. coli (Hemorrhagic) Culture, Stool, HECCU. Routine stool cultures are not recommended from patients hospitalized for greater than 3 days, unless the patient is known to be HIV positive or the request has been approved by the Microbiology Medical Director. |
| Revised: | 6/21/2021 |