Bacteria - Culture & Sensitivities – Stool

C&S Stool
Microbiology
Bacteriology
○ FecalSwabTM ○ Stool ○ Rectal or large bowel/colon biopsies ○ Duodenal or small bowel swab ○ Rectal swab (only acceptable if stool cannot be obtained.)
Other Information
Routine stool cultures include screening for the presence of Salmonella species, Shigella species, Campylobacter species, E.coli O157:H7 (and Yersinia species in children between 1 month and 12 years of age).
○ Routine stool culture will not identify C. difficile infection. Please ensure that the appropriate testing for C. difficile toxin has been ordered.
○ If additional enteric bacterial pathogens are suspected (e.g. Aeromonas species, Plesiomonas shigelloides, Vibrio species or Yersinia species [in children greater than 12 years of age or adults]), please notify the laboratory and indicate on the requisition which organisms testing is required for. Each of the organisms mentioned above will have additional culture media (non-routine) added upon request. All specimens submitted for stool culture will be processed for routine enteric bacterial pathogens.
○ If Campylobacter species other than C. jejuni/coli is suspected, collect the specimen in a clean, sterile container and the specimen will be forwarded to the Provincial Health Laboratory for testing
○ If parasitic causes of infection are suspected, see: Ova and Parasites – Stool to ensure that the appropriate specimen collection devices are used. Specimens submitted for Ova and Parasites in SAF fixative cannot be used for bacterial culture
○ Stool culture will not be performed if patients have been hospitalized for more than 3 days unless approval by the microbiologist-on-call has been obtained.
Detection of enteric bacterial pathogens in stool
○ FecalSwabTM: Refer to Fecal Swab Collection Method in Appendix
○ Stool: Single specimen in Cary-Blair transport medium (i.e. Enteric Pathogen Transport medium) OR clean leakproof, wide mouth container (if specimen can be received in the lab within 2 hours of collection)
○ Rectal or large bowel/colony biopsy: Sterile container with small amount of normal saline
○ Rectal or duodenal/small bowel swab: swab in FecalSwabTM
FecalSwabTM:
Refer to Fecal Swab Collection Method in Appendix
Stool:
○ Pass stool into a clean, dry pan or container mounted on the toilet. Collect at least 5 mL of watery diarrheal stool (10 to 30 mL preferred), approximately 1 gram of fecal material or a walnut-sized portion of stool or a sufficient amount of stool to the line of the transport container. Transport to the laboratory immediately after collection
○ Do not overfill specimen collection container (e.g. above fill line) as it will compromise specimen preservation
Rectal or large bowel/colon biopsies
○ Collect specimen via a colonoscope or sigmoidoscope and transport in a clean sterile container with a small amount of sterile saline or Cary-Blair transport medium (i.e. Enteric Pathogen Transport medium).

Duodenal or small bowel swab
○ Collect specimen from duodenum or small bowel during surgery and place into FecalSwabTM container.
Rectal swab:
○ Collect the specimen with a sterile swab inserted approximately one inch beyond the anal sphincter using a FecalSwabTM. Rectal swabs are only acceptable if stool cannot be obtained.
Refer to section Sample Processing / Delivery
In-house
○ up to 72 h
416-586-4800 extension 4432
NO
○ Label specimen container. Place specimens in biohazard bag and seal.

○ Specimens can be held at room temperature (20-25˚C) after collection and transported to the UHN/SH Microbiology Laboratory ASAP after collection. If a delay of more than 2 hours in transport is anticipated, the specimen should be refrigerated (2-8˚C).