SP 10.13 A Comparison of Rectal Swabs Versus Traditional Stool Samples for Detection of Enterogenic Pathogens Causing Acute Gastroenteritis - A Meta-Analysis
Kavya Francis, Georgios Geropoulos, Rohan Bhawdip Patel, William J Broadhurst, Jared M Wohlgemut, Nicola ColucciAbstract
Background
Acute gastroenteritis is a common presentation to hospital and can range from mild to life-threatening in severity. Traditional stool cultures can often pose logistical problems including delayed sample collection if there is no passage of stools, greater exposure hence risk of transmission and at least 24-48 hours before result processing. This meta-analysis therefore aims to assess the diagnostic performance of rectal swabs as an alternative diagnostic tool to aid prompt detection of enteropathogens.
Methods
A total of 16 studies were included which directly compared paired rectal swabs/ dipsticks to stool samples to assess detection rates of enterogenic bacteria, viruses and/or parasites in acute gastroenteritis.
Results
Our analysis showed that rectal swabs had an overall sensitivity of 90.2% (95% CI 76.8%, 95.6%) and a specificity of 92.2% (95% CI 77.3%, 96.8%) when detecting enteropathogens as compared to stool samples. This was further divided into group-specific analysis which showed an overall sensitivity of 89.0% (95% CI 64.1%, 96.8%) and specificity of 95.7% (95% CI 89.0%, 97.9%) for bacteria and sensitivity of 88.4% (95% CI 63.2%, 96.8%) and specificity of 93.0% (95% CI 72.0%, 97.1%) for viruses. Pathogens with the highest detection rates included norovirus and shigella.
Conclusion
Rectal swabs have immense potential as diagnostic tools to detect enteropathogens in a clinical environment especially when obtaining stool samples might prove difficult. Timely detection of pathogens is crucial to establish infection control policies, limit outbreaks, and promptly treat patients presenting with acute gastroenteritis.