Confine testing to symptomatic patients. Testing of patients with formed stools may generate false positives due to asymptomatic carriage of toxigenic strains. An unfortunate side effect of multiplex PCR stool assays, are that tests that are inappropriate to the clinical circumstance may be performed, generating false positives.
Also test at-risk (i.e. antibiotic or ppi-exposed) symptomatic patients from the community – recent Australian data showed up to 26% of diagnoses of CDI occurred in patients who have had no contact with healthcare.
Avoid re-testing CDI patients post recovery – persistent carriage of the toxigenic organism is the norm despite treatment. A recovered patient may remain positive for at least one month.
Patients with C. difficile generally do not go under the radar, although there are well-documented cases of severe C. difficile that only get recognised post mortem (for instance, severe C. difficile may be associated with an ileus and/or sepsis and significant enteritis may not get considered).
CDI= C. difficile infection PPI = proton pump inhibitor drug, also a risk factor for CDI
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