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Evidence‐based approaches

Rationale

Timely and accurate identification of patients with infective diarrhoea is crucial in individual management of colonization and within the context of effective infection control management. Obtaining the specimen provides important diagnostic information that can be used to decide how to manage the patient's condition and the mode of treatment (PHE [184]). Prompt diagnosis can influence aspects of care such as isolation and cohort nursing of infected patients, infection control procedures, environmental decontamination and antibiotic prescribing (Loveday et al. [128], PHE [184]).

Indications

Collection of a faecal specimen is indicated:

to identify an infective agent in the presence of chronic, persistent or extended periods of diarrhoea
if patients are systemically unwell with symptoms of diarrhoea, nausea and vomiting, pain, abdominal cramps, weight loss and/or fever
to investigate diarrhoea occurring after foreign travel
to identify parasites, such as tapeworms
to identify occult (hidden) blood if rectal bleeding is suspected in the presence of diarrhoea associated with prolonged antibiotic administration
for symptomatic contacts of individuals with certain organisms where an infection can have serious clinical sequelae (PHE [184])
for bowel cancer screening.

Contraindications

Collection of a faecal specimen is not indicated:

as routine testing
in the absence of diarrhoea in suspected infective colonization.

Principles of care

A sample should be obtained as soon as possible after the onset of symptoms, ideally within the first 48 hours of illness, as the chance of successfully identifying a pathogen diminishes once the acute stage of the illness passes (Weston [255]).