A High Rate of Alternative Diagnoses in Patients Referred for Presumed Clostridium difficile Infection

Area of Science:

• Gastroenterology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Rising rates of Clostridium difficile infection (CDI) lead to increased diagnoses of recurrent CDI.
• Differentiating symptomatic CDI from colonization with other diarrheal causes can be difficult.

Purpose of the Study:

• To determine the final diagnoses and outcomes for patients referred for presumed recurrent CDI.
• To assess the accuracy of initial CDI diagnoses by referring providers.

Main Methods:

• Retrospective review of 117 patients referred for recurrent CDI (January 2013 - June 2014).
• Collected data included demographics, prior treatments, medical conditions, and atypical CDI features.
• Analyzed rates of alternative diagnoses and confirmed CDI diagnoses.

Main Results:

• 25% of referred patients (29/117) received a non-CDI diagnosis, most commonly irritable bowel syndrome (62% of non-CDI cases).
• Alternative diagnoses were more common in younger patients (inverse correlation with age, P=0.016).
• Of confirmed CDI cases (88/117), 72% underwent fecal microbiota transplantation.

Conclusions:

• A significant proportion of patients referred for recurrent CDI have alternative diagnoses, primarily irritable bowel syndrome.
• Age is a key factor in the likelihood of an alternative diagnosis.
• Clinicians should consider non-CDI etiologies in patients with atypical recurrent CDI symptoms.