Stool specimens in patients hospitalized for > 3 days should not be submitted for stool diagnostic studies unless patient admitted with diarrhea or there is nosocomial outbreak of diarrhea. Diarrhea in hospitalized children (≥ 1 year old) warrants investigation for Clostridioides (Clostridium) difficile.
Recommend blood culture if febrile and systemically unwell.
Causes of bloody diarrhea:
Nontyphoidal Salmonella spp
Shiga toxin-producing E. coli, including E. coli O157:H7
Vibrio spp, not V. cholerae
- C. difficile
Severe bloody diarrhea in afebrile patients should increase suspicion of E. coli O157:H7. Most common in children < 5 years old.
Avoid antimotility agents in children < 2 years old, or in children of any age if fever present and/or if blood in stool.