Stool Culture with Shiga Toxin and Campylobacter (Shiga Toxin and Campylobacter testing performed by EIA)

Performed in Microbiology
Screen for Vancomycin-Resistant Enterococcus spp refer to C VRE (must be ordered separate from the stool culture)
Culture for Yersinia refer to C YER (must be ordered separate from the stool culture)
Culture for Vibrio refer to C VIB (must be ordered separate from the stool culture)
Stool for C difficile by Rapid Immunoassay for GDH and Toxins A/B refer to CDIFFGDH
Test for Rotavirus by EIA refer to S ROTAVIRS
Stool for AFB culture refer to C AFB

C STT

Routine stool culture includes exam for the following:
Salmonella
Shigella
Campylobacter testing by EIA
Shiga Toxin (E.coli O157 et al) testing by EIA
NOTE: if considering extraintestinal Campylobacter, submit routine blood cultures or other body fluid for culture as specified by clinician

Routine stool culture DOES NOT include exam for the following:
Vibrio species
Yersinia enterocolitica
Screen for Vancomycin- Resistant Enterococcus spp

• Preserved stool placed in Para-Pak C&S vial (orange lid) by nursing unit immediately after collection.
• Raw stool received in the laboratory <2 hours after collection.
  NOTE: The laboratory will place the raw stool in a C&S Para-Pak (orange lid) upon receipt/ immediately.
• Rectal swab (using routine culture swabs or eSwabs)- for routine culture only.
• Duodenal aspirate placed in Para-Pak C&S vial (orange lid) by nursing unit immediately after collection.

Stool or Duodenal aspirate placed in the C&S Para-Pak transport vial, must be filled to the required level on the vial.
Raw stool: 1 gram solid stool, of 5mL liquid stool 
Quantities/volumes less than the mininum specimen required will be cancelled.

NOTE:  Guidelines suggest rejection of specimen for routine C&S and O&P after the third hospital day.  Suggested test for diarrhea occurring after 3 days of hospitalization is C. difficile Rapid Immunoassay (CDIFFGDH).
NOTE: A stool swab is not acceptable for AFB or Fungal cultures.

C&S Para-Pak (orange lid) transport container
Sterile screw capped container.
Rectal swab - routine culture swabs or eSwabs in transport media (Amies) - for routine culture only.

Ambient / Room Temperature

Unpreserved/ raw stool is stable for 2 hours after collection. If unpreserved/ raw stool is received in the lab after 2 hours, the specimen will be rejected and the test cancelled.
Preserved stool (in a Para-Pak C&S container) is stable for 96 horus after collection. If preserved stool is received in the lab after 96 hours, the specimen will be rejected and the test cancelled.
Eswabs are stable for up to 48 hours.
Any stool specimens sent refrigerated or frozen will be rejected and the test cancelled.

If unpreserved/raw stool is received in the lab > 2 hours after collection, specimen will be rejected and the test cancelled.
If rapid transport to the lab is a problem, use Para-Pak C&S transport system instead (follow kit directions on how to collect).
If preserved stool is collected and placed into a Para-Pak C&S transport system, the specimen is stable for 96 hours. If Para-Pak C&S transport system is received after 96 hours, the specimen will be rejected and the test cancelled.
Any specimens sent refrigerated or frozen will be rejected and cancelled.

Unacceptable specimens:
Diapers
Stool in O&P preservative/ total fix vials
Rectal swabs in VTM
Dried out stool or swabs
Raw stool older than 2 hours which is not placed in transport media
Any specimen sent frozen or refrigerated
Any specimen placed in Para-Pak C&S transport system and received after 96 hours

Campylobacter testing performed by EIA - report available <24 hours
ShigaToxin performed by EIA  - report available <24 hours
Preliminary culture report will be available <24 hours
A final negative culture report will be available <3 days
All positive cultures will be reported immediately
 

Salmonella, Shigella, and Campylobacter are considered pathogens when isolated from stool. Identification of these organisms is important for treatment and infection control. The Shiga toxin assay detects toxins produced by enterohemorrhagic E. coli and other enteric organisms which have been isolated from patients who have hemorrhagic colitis with or without hemolytic-uremic syndrome (HUS).

NOTE: Without a specific request for Vibrio or Yersinia, selective medium will not be inoculated and these pathogens may or may not be detected in culture (see Culture, Vibrio and Culture, Yersinia).