Choosing Wisely:

Avoid testing for a Clostridium difficile infection in the absence of diarrhea.

Rationale and Comments: Testing for Clostridium difficile or its toxins should be performed only on diarrheal (unformed) stool, unless ileus due to Clostridium difficile is suspected. Because Clostridium difficile carriage is increased in patients on antimicrobial therapy and in patients in the hospital, only diarrheal stools warrant testing. In the absence of diarrhea, the presence of Clostridium difficile indicates carriage and should not be treated and, therefore, not tested.
Sponsoring Organizations:
  • Infectious Diseases Society of America
  • Sources:
  • SHEA/IDSA guidelines
  • Disciplines:
  • Infectious disease
  • Gastroenterologic
  • References: • Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-55.
    • Surawicz, Christina M, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478-98.

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