New culture-independent tests are more sensitive than traditional diagnostic methods in detecting the cause of infectious diarrhea but because they are so sensitive and may detect multiple organisms, expertise may be necessary to interpret clinical significance and appropriate public health surveillance, according to the guidelines.
Andi L. Shane, lead author of them, said diagnostic testing combined with clinical expertise is helpful in identifying a cluster of infections that may signal an outbreak.
“However, even if they don’t need to be tested, most people will benefit from rehydration therapy while waiting for the infection to run its course,” added the associate professor of pediatric infectious diseases, Emory University School of Medicine and Children’s Healthcare of Atlanta.
Most people with diarrhea do not need to be tested but children younger than five, the elderly, immune-compromised people and those with bloody diarrhea, abdominal pain or tenderness or signs of sepsis should be considered for diagnostic testing.
Culture-independent diagnostic tests (CIDTs) are more sensitive than the culture-based tests traditionally used. However, they may detect organisms with which physicians are unfamiliar or find more than one microbe.
Guidelines include seven tables that clinicians can reference for information about the ways people acquire the microbes, exposure conditions, post-infectious symptoms and clinical presentation, as well as recommended antimicrobial, fluid and nutritional management.
Larry Pickering, co-author of the guidelines, said clinicians must be astute and notice if they are seeing patients with an unusual infection or similar infections from a specific location and then work with state and local health authorities.
“This is the optimal way to develop community awareness and use an integrated approach to identify and contain an outbreak,” said the adjunct professor of pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta.