{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T17:51:06Z","timestamp":1773165066674,"version":"3.50.1"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T00:00:00Z","timestamp":1543881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Team Collaborative Research Innovation Opportunity"},{"name":"Biobank Core of the Washington University Digestive Diseases Research Core Center","award":["P30DK052574"],"award-info":[{"award-number":["P30DK052574"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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\u2019s stool for bacterial enteropathogens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children &amp;lt;18 years old who presented with \u22653 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\u2013producing 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u201333.0%) to 66.9% (95% CI 59.3\u201374.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6\u201365.6%) to 96.5% (95% CI 95.7\u201397.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciy1021","type":"journal-article","created":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T20:17:28Z","timestamp":1543522648000},"page":"1173-1182","source":"Crossref","is-referenced-by-count":22,"title":["Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children With 9 Potential Bacterial Enteropathogens"],"prefix":"10.1093","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7372-1034","authenticated-orcid":false,"given":"Gillian A M","family":"Tarr","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Chui","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonita E","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Women and Children\u2019s Health Research Institute, University of Alberta, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao-Li","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samina","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Women and Children\u2019s Health Research Institute, University of Alberta, Alberta, Canada"},{"name":"Department of Emergency Medicine, Women and Children\u2019s Health Research Institute, University of Alberta, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Nettel-Aguirre","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and Community Health Sciences, University of Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Otto G","family":"Vanderkooi","sequence":"first","affiliation":[{"name":"Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children\u2019s Hospital Research Institute, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byron M","family":"Berenger","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada"},{"name":"Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Dickinson","sequence":"first","affiliation":[{"name":"Department of Family Medicine, University of Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip I","family":"Tarr","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Drews","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy","family":"MacDonald","sequence":"first","affiliation":[{"name":"Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B","family":"Freedman","sequence":"first","affiliation":[{"name":"Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children\u2019s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,12,4]]},"reference":[{"key":"2020071003341879500_CIT0001","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1136\/gut.2011.238386","article-title":"Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and 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