Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children with 9 Potential Bacterial Enteropathogens

Gillian A.M. Tarr, Linda Chui, Bonita E. Lee, Xiao Li Pang, Samina Ali, Alberto Nettel-Aguirre, Otto G. Vanderkooi, Byron M. Berenger, James Dickinson, Phillip I. Tarr, Steven Drews, Judy MacDonald, Kelly Kim, Stephen B. Freedman

Research output: Contribution to journalArticle

2 Scopus citations


Background: The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool-testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated 6 leading gastroenteritis guidelines (eg, those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens. Methods: Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children <18 years old who presented with ≥3 episodes of diarrhea and/or vomiting in a 24-hour period. All participants were tested for 9 bacterial enteropathogens: Aeromonas, Campylobacter, Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, Salmonella, Shigella, Vibrio, and Yersinia. Patient data gathered at the index visit were used to determine whether guidelines would recommend testing. Sensitivity and specificity to recommend testing for children with bacterial enteropathogens were calculated for each guideline. Results: Outcome data were available for 2391 (97.7%) participants, and 6% (144/2391) of participants tested positive for a bacterial enteropathogen. Guideline sensitivity ranged from 25.8% (95% confidence interval [CI] 18.7-33.0%) to 66.9% (95% CI 59.3-74.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6-65.6%) to 96.5% (95% CI 95.7-97.2%). Conclusions: No guideline provided optimally balanced performance. The most sensitive guidelines missed one-third of cases and would drastically increase testing volumes. The most specific guidelines missed almost 75% of cases.

Original languageEnglish
Pages (from-to)1173-1182
Number of pages10
JournalClinical Infectious Diseases
Issue number7
StatePublished - Sep 13 2019


  • acute gastroenteritis
  • culture-independent diagnostic testing
  • enteric bacteria
  • laboratory utilization
  • stool culture

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