title: The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease.
abstract: OBJECTIVE
  We sought to determine the yield of stool analysis for bacterial culture, ova and parasites, and Clostridium difficile toxin in suspected relapses of inflammatory bowel disease (IBD).
  
  
  BACKGROUND
  The diagnostic yield of such stool studies has not been examined recently in the United States.
  
  
  METHODS
  The medical records of consecutive IBD patients who underwent stool testing for relapses at our institution between July 1, 2000, and November 25, 2001, were abstracted for demographics, stool test results, recent antibiotic exposure, and hospitalization.
  
  
  RESULTS
  Fifty-four patients were evaluated during 62 relapses with 99 stool samples. Twelve stool tests were positive. C. difficile accounted for the majority of positive tests (10/12). Of these, 9 (90%) were associated with antibiotic use in the prior month versus 10 (22%) in the C. difficile-negative group (P < 0.001). Hospitalization, prednisone use, or sulfasalazine use did not differ significantly with C. difficile status. Eight C. difficile-positive patients improved clinically with targeted antibiotic therapy. Two bacterial cultures (4%) were positive for Campylobacter jejuni and Plesiomonas shigelloides.
  
  
  CONCLUSIONS
  Stool studies yielded a pathogen, mainly C. difficile, in 20% of the relapsing IBD patients. Antibiotic use was significantly associated with a positive C. difficile toxin. Toxin-positive patients improved clinically with targeted antibiotics.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Meyer
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Ramzan
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Russell I
authors.initials: RI
authors.lastname: Heigh
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Leighton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016123:Campylobacter jejuni / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016981:Plesiomonas / Q000302:isolation & purification; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D012460:Sulfasalazine; D011239:Prednisolone