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Does My Patient Have Clostridium difficile Infection?
- Lance R. Peterson, MD; and
- Ari Robicsek, MD
Abstract
Clostridium difficile infection (CDI) seems to be changing—with increasing virulence and incidence, more resistance to metronidazole, and worse outcomes. Accurate diagnosis is critical, but 3 common misconceptions lead to misdiagnosis: Clostridium difficile infection is a possibility when the patient has fewer than 3 loose stools per day; the glutamate dehydrogenase test for CDI is sensitive and thus is a good initial test; and repeating an insensitive laboratory test for CDI is useful. These misconceptions can lead to missed diagnoses (for example, when tests with low sensitivity are used) and to false diagnoses (for example, when tests are done in patients who are unlikely to have CDI because they have minimal diarrhea or negative results on recent tests). Diagnoses of CDI will be more accurate if clinicians use tests with a higher sensitivity, reduce the frequency of testing for a single episode of diarrhea, and give more attention to key elements of the patient's history.
Article and Author Information
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Grant Support: There was no sponsorship or funding outside of the authors' organization, NorthShore University HealthSystem, for this work. The authors are solely responsible for this report.
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Potential Financial Conflicts of Interest: Consultancies: L.R. Peterson (BD-GeneOhm, Cepheid, MicroPhage, Nanosphere, Roche). Honoraria: L.R. Peterson (BD-GeneOhm; Cepheid; Roche; as well as numerous universities, scientific/professional organizations, and governmental bodies for lectures on rapid diagnostic testing), A. Robicsek (Becton Dickinson). Grants received: L.R. Peterson (BD-GeneOhm, Cepheid, MicroPhage, Nanogen, Nanosphere, National Institute of Allergy and Infectious Diseases, Roche, 3M, Washington Square Health Foundation), A. Robicsek (Becton Dickinson). Grants pending: L.R. Peterson (BD-GeneOhm, Cepheid, MicroPhage, Nanosphere, National Institute of Allergy and Infectious Diseases, Roche, The Retirement Research Foundation).
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Reproducible Research Statement: Study protocol: Available from Dr. Peterson (e-mail, lancer{at}northwestern.edu). Statistical code and data set: None.
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Requests for Single Reprints: Lance R. Peterson, MD, NorthShore University HealthSystem, Department of Pathology and Laboratory Medicine, Walgreen SB525, 2650 Ridge Avenue, Evanston, IL 60201; e-mail, lancer{at}northwestern.edu.
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Current Author Addresses: Dr. Peterson: NorthShore University HealthSystem, Department of Pathology and Laboratory Medicine, Walgreen SB525, 2650 Ridge Avenue, Evanston, IL 60201.
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Dr. Robicsek: NorthShore University HealthSystem, Department of Infection Control, Burch 124, 2650 Ridge Avenue, Evanston, IL 60201.
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Author Contributions: Conception and design: L.R. Peterson, A. Robicsek.
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Analysis and interpretation of the data: L.R. Peterson, A. Robicsek.
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Drafting of the article: L.R. Peterson.
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Critical revision of the article for important intellectual content: L.R. Peterson, A. Robicsek.
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Final approval of the article: L.R. Peterson, A. Robicsek.
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Provision of study materials or patients: L.R. Peterson.
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Statistical expertise: L.R. Peterson.
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Administrative, technical, or logistic support: L.R. Peterson.
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Collection and assembly of data: L.R. Peterson.
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