What is the recommended approach to testing for C. difficile infection?

What is the recommended approach to testing for C. difficile infection?

• A. Lab testing is performed only on symptomatic patients.
• B. Testing is performed regardless of symptoms.
• C. Test of cure is recommended after treatment.
• D. Stool testing is not used for C. difficile.

Answer: (A)

Testing for C. difficile should be done only in patients who have clinically significant symptoms, specifically new or worsening diarrhea. Asymptomatic carriage is common, especially in older adults and in healthcare settings, so testing people without diarrhea can yield positive results that don’t reflect active infection. That leads to unnecessary treatment, isolation, and confusion. In practice, suspect CDI when there are three or more unformed stools in 24 hours (or persistent, unexplained diarrhea in someone recently treated with antibiotics). Do not test formed stools and do not screen asymptomatic individuals. Also, testing after treatment to document cure isn’t recommended because people can continue to shed nonviable organisms even after symptoms resolve, so a positive test after therapy doesn’t reliably indicate ongoing infection.

Testing for C. difficile should be done only in patients who have clinically significant symptoms, specifically new or worsening diarrhea. Asymptomatic carriage is common, especially in older adults and in healthcare settings, so testing people without diarrhea can yield positive results that don’t reflect active infection. That leads to unnecessary treatment, isolation, and confusion.

In practice, suspect CDI when there are three or more unformed stools in 24 hours (or persistent, unexplained diarrhea in someone recently treated with antibiotics). Do not test formed stools and do not screen asymptomatic individuals. Also, testing after treatment to document cure isn’t recommended because people can continue to shed nonviable organisms even after symptoms resolve, so a positive test after therapy doesn’t reliably indicate ongoing infection.