Recommendations

Australasian Society for Infectious Diseases

4.
Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms.

Testing of faeces for microscopy and culture or by PCR methods should not be performed in the absence of diarrhoea or other gastro-intestinal symptoms. Similarly antimicrobial treatment for a gastrointestinal pathogen is not indicated in the absence of symptoms. For immunocompetent non-traveller children with acute gastroenteritis, there are very few circumstances when a stool test for infection would alter clinical management. Possible exceptions include refugee screening and some neurological syndromes such as enteroviral testing for acute flaccid paralysis.

Supporting evidence
  • Cohen SH, Gerding DN, Johnson S. Clinical practice guidelines for clostridium difficile infection in adults: 2010 Update. Infection Control and Hospital Epidemiology 2010;31(5):431-55.
  • Letter,dated 26/05/15, from the Australian and New Zealand Paediatric Infectious Diseases Group (ANZPID) to the Royal College of Pathologists of Australasia (RCPA) concerning the significant impact that stool multiplex PCR was having on requests for ID physician opinions and appointments for children, particularly regarding positive results for Blastocystis hominis and Dientamoeba fragilis.
  • Hewison CJ, Heath CH, Ingram PR. Stool culture. Australian Family Physician 2012:41(10).
  • Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines
How this list was made How this list was made

An initial list of 10 low value interventions was compiled by the Lead Fellow of the Australasian Society for Infectious Diseases (ASID) Inc following an online discussion in ASID's discussion forum, Ozbug. The Royal Australasian College of Physicians (RACP) then facilitated a consultation of all ASID members via a survey distributed through the society’s e-newsletter. In the survey, members were asked to rank the 10 suggested interventions and suggest additional items for consideration. A subsequent shortlist of items was created by selecting the top 7 interventions as ranked by the members from the initial list.

The shortlist was sent to ASID’s special interest groups and selected members who had agreed to assist, who were asked to recommend the items to comprise the ‘top 5’. This final list was endorsed by ASID Council on 31 July 2015. The Top 5 was then circulated again to the ASID members for final comments before being signed off by ASID’s Executive Committee.