Diagnostic yield of stool culture and probable predictive factors A single-center experience

Main Article Content

Mohamad Zaki Alzaher https://orcid.org/0000-0002-0524-7593
Abdulelah Abdulrahman Almugahwi https://orcid.org/0000-0001-8377-5386
Ali Abdullah Almulla https://orcid.org/0000-0002-0007-6713
Hashim Hadi Almeer https://orcid.org/0000-0002-7999-3804
Mustafa Mohammed Alshammasi https://orcid.org/0000-0002-0904-2624
Ayman A. El-Badry https://orcid.org/0000-0002-9673-2622


Stool analysis, stool culture, Pathogens, Gastrointestinal, Antibiotic resistance


Background and aim: Stool analysis is commonly performed to diagnose certain gastrointestinal diseases. The diagnostic yield of stool culture,  a method of stool analysis, is variable worldwide and is unclear in the Kingdom of Saudi Arabia. This study was conducted to determine the diagnostic yield of stool culture from the year 2008 to 2020 and to determine the predictors for a positive stool culture. Furthermore, antibiotic susceptibility patterns of the detected copro-pathogens in the same time period were collected and studied.

Methods: This is a retrospective case-control study in which patients’ data was collected from the hospital’s electronic health record. The results of all stool analyses performed from 2008 to 2020 and associated patients’ characteristics were collected.  Characteristics of cases with a positive stool culture were compared to the characteristics of those without to identify the predictors for positive stool cultures.

Results: Copro-pathogens were detected in 89.4% of cultured stool samples. Salmonella spp (1590/1775, 89.6%) was the most common organism followed by Shigella spp. (84/1775, 4.7%) and Campylobacter spp (45/1775, 2.5%). Male sex, the 1-5 age group, positive fecal occult blood test results, and positive stool leukocyte test results were associated with a positive stool culture result. Cultured copro-pathogens were highly sensitive to Trimethoprim/Sulfamethoxazole and Ampicillin.

Conclusions: Stool analysis was found to be a test of high diagnostic yield. However, there is still a need for more studies on this subject with a focus on possible predictive factors for specific organisms.


Download data is not yet available.
Abstract 104 | PDF Downloads 59


1. Jessee M. Stool studies: tried, true, and new. Crit Care Nurs Clin North Am 2010;22:129-45.
2. Hewison C, Heath C, Ingram P. Stool culture. Aust Fam Physician 2012;41:775-9.
3. Al-Tawfiq J, Rabaan A, Bazzi A, Raza S, Noureen M. Clostridioides (Clostridium) difficile-associated disease: Epidemiology among patients in a general hospital in Saudi Arabia. Am J Infect Control 2020;48:1152-7.
4. Bakarman M, Hegazi M, Butt N. Prevalence, Characteristics, Risk Factors, and Impact of Intestinal Parasitic Infections on School Children in Jeddah, Western Saudi Arabia. J Epidemiol Glob Health 2019;9:81-7.
5. Eligail A, Masawi A, Al-Jaser N, Abdelrahman K, Shah A. Audit of stool analysis results to ensure the prevalence of common types of intestinal parasites in Riyadh region, Saudi Arabia. Saudi J Biol Sci 2010;17:1-4.
6. Qadri S, Al-Qatary K, Tufenkeji H, Cunha B. Etiology of bacterial diarrhea in a major referral center in Saudi Arabia. Ann Saudi Med 1991;11:633-6.
7. Wakid M. Fecal occult blood test and gastrointestinal parasitic infection. J Parasitol Res 2010;2010:434801.
8. Koplan J, Fineberg H, Ferraro M, Rosenberg M. Value of stool cultures. Lancet 1980;2:413-6
9. Meropol S, Luberti A, De Jong A. Yield from stool testing of pediatric inpatients. Arch Pediatr Adolesc Med 1997;151:142-5.
10. Lee J, Cho S, Hwang H, et al. Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness. Medicine (Baltimore) 2017;96:e7641.
11. Meyer A, Ramzan N, Loftus E, Heigh RI, Leighton JA. The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease. J Clin Gastroenterol 2004;38:772-5.
12. Denno D, Stapp J, Boster D, et al. Etiology of diarrhea in pediatric outpatient settings. Pediatr Infect Dis J 2005;24:142-8.
13. Deorari S, McConnell A, Tan KK, et al. Differential yield of pathogens from stool testing of nosocomial versus community-acquired paediatric diarrhea. Can J Infect Dis 1999;10:421-8.
14. Kaminski N, Bogomolski V, Stalnikowicz R. Acute bacterial diarrhoea in the emergency room: therapeutic implications of stool culture results. J Accid Emerg Med 1994;11:168-71.
15. Luo Y, Yi W, Yao Y, Zhu N, Qin P. Characteristic diversity and antimicrobial resistance of Salmonella from gastroenteritis. J Infect Chemother 2018;24:251-5.
16. Somily A, Sayyed S, Habib H, et al. Salmonella isolates serotypes and susceptibility to commonly used drugs at a tertiary care hospital in Riyadh, Saudi Arabia. J Infect Dev Ctries 2012;6:478-82.
17. Elhadi N, Aljindan R, Aljeldah M. Prevalence of nontyphoidal Salmonella serogroups and their antimicrobial resistance patterns in a university teaching hospital in Eastern Province of Saudi Arabia. Infect Drug Resist 2013;6:199-205.
18. Wei Z, Xu X, Yan M, et al. Salmonella Typhimurium and Salmonella Enteritidis Infections in Sporadic Diarrhea in Children: Source Tracing and Resistance to Third-Generation Cephalosporins and Ciprofloxacin. Foodborne Pathog Dis 2019;16:244-55.
19. DeWitt T, Humphrey K, McCarthy P. Clinical predictors of acute bacterial diarrhea in young children. Pediatrics 1985;76:551-6.
20. Cadwgan A, Watson W, Laing R, MacKenzie A, Smith C, Douglas J. Presenting clinical features and C-reactive protein in the prediction of a positive stool culture in patients with diarrhoea. J Infect 2000;41:159-61.
21. Riaz M, Patel M, Khan M, et al. Clinical characteristics and predictors of positive stool culture in adult patients with acute gastroenteritis. J Pak Med Assoc 2012;62:20-4.
22. Chan S, Ng K, Lam P, Lyon D, Cheung W, Rainer T. Predictors of positive stool culture in adult patients with acute infectious diarrhea. J Emerg Med 2002;23:125-30.
23. Alam M, Akhtar Y, Ali S, et al. Seasonal variation in bacterial pathogens isolated from stool samples in Karachi, Pakistan. J Pak Med Assoc 2003;53:125-9.
24. McGregor A, Whitty C, Wright S. Geographic, symptomatic and laboratory predictors of parasitic and bacterial causes of diarrhoea in travellers. Trans R Soc Trop Med Hyg 2012;106:549-53.