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Related Experiment Videos

Should all stool specimens be routinely tested for Clostridium difficile?

Anne-Marie Bourgault1, Ariane Yechouron, Christiane Gaudreau

  • 1Centre hospitalier de l'Université de Montréal (Pavillon Saint-Luc), and.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|February 22, 2002
PubMed
Summary

Routine laboratory screening for Clostridium difficile (C. diff) is crucial for outpatients and short-stay patients. Many C. diff cases, particularly those with cytotoxin, are missed without universal testing, indicating under-diagnosis.

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Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Gastroenterology

Background:

  • Clostridium difficile infection (CDI) is a significant cause of infectious diarrhea, particularly in healthcare settings.
  • Current diagnostic approaches may miss CDI in certain patient populations, such as outpatients and those with short hospital stays.
  • The utility of routine laboratory screening for CDI in these groups requires further investigation.

Purpose of the Study:

  • To determine the frequency of Clostridium difficile detection in stool specimens from outpatients and patients hospitalized for less than 4 days.
  • To assess the effectiveness of routine laboratory screening for identifying this enteric pathogen.
  • To evaluate the diagnostic yield of universal Clostridium difficile testing in a mixed patient population.

Main Methods:

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  • A 6-month prospective study involving 741 stool specimens from 398 patients.
  • Stool cultures were performed for common enteric pathogens, including Clostridium difficile.
  • Clostridium difficile positive samples were tested for cytotoxin production.

Main Results:

  • Clostridium difficile was the second most frequent enteric pathogen identified.
  • Of 88 Clostridium difficile positive specimens, cytotoxin was detected in 35 (4.7%).
  • Nine out of 12 patients with cytotoxin-positive results would have been undiagnosed without universal testing.

Conclusions:

  • Clostridium difficile infection appears to be under-recognized in outpatients and short-stay hospitalized patients.
  • Routine laboratory screening of all stool samples for Clostridium difficile may be warranted to improve diagnosis.
  • Universal testing could significantly increase the detection rate of Clostridium difficile disease in this patient cohort.