Choosing Wisely:

Don’t obtain a Clostridium difficile toxin test to confirm “cure” if symptoms have resolved.

Rationale and Comments: Rates of C. difficile infection have been increasing, especially among older adults who have recently been hospitalized or who reside in the post-acute and long-term care setting. Patients residing in post-acute and long-term care facilities are particularly at risk for C. difficile infection because of advanced age, frequent hospitalizations and frequent antibiotic exposure. Studies show that up to 57% of patients in the post-acute and long-term care setting are asymptomatic carriers of C. difficile. Furthermore, studies have also shown that C. difficile tests may remain positive for as long as 30 days after symptoms have resolved. False positive “test-of-cure” specimens may complicate clinical care and result in additional courses of inappropriate anti-C. difficile therapy. To limit the spread of C. difficile, care providers in the post-acute and long-term care setting should concentrate on early detection of symptomatic patients and consistently use proper infection control practices, including hand washing with soap and water.
Sponsoring Organizations:
  • Society for Post-Acute and Long-Term Care Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gastroenterologic
  • Infectious disease
  • References: • Riggs MM, Sethi AK, Zabarsky TF, Eckstein EC, Jump RL, Donskey CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis. 2007 Oct 15;45 (8):992.
    • Surawicz CM, 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 Apr;108(4):478–98.

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