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Factors associated with repeat Clostridioides difficile testing in VA medical centers

Geneva M Wilson1,2, Lishan Cao1, Margaret A Fitzpatrick3,4

  • 1Center of Innovation for Complex Chronic Healthcare, https://ror.org/02223wv31Edward Hines, Jr. VA Hospital, Hines, IL, USA.

Infection Control and Hospital Epidemiology
|October 21, 2025
PubMed

Insights

Clostridioides difficile infection (CDI) guidelines recommend against retesting within 7 days. This study found residents ordered more repeat CDI tests than attending physicians or advanced practice practitioners.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Healthcare Quality

Background:

  • Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
  • Current guidelines recommend against repeat diagnostic testing for CDI within 7 days of a previous positive test.
  • Inappropriate repeat testing can lead to increased healthcare costs and potential patient harm.

Purpose of the Study:

  • To identify factors associated with ordering repeat diagnostic tests for Clostridioides difficile infection within 7 days.
  • To evaluate the impact of healthcare provider type on the frequency of 7-day repeat testing for CDI.

Main Methods:

  • Retrospective cohort study design.
  • Analysis of electronic health records to identify CDI testing patterns.
  • Statistical analysis, including adjusted odds ratios (aOR), to determine factors associated with repeat testing.

Main Results:

  • Residents ordered repeat Clostridioides difficile infection tests more frequently compared to attending physicians (aOR = 0.67) and advanced practice practitioners (aOR = 0.61).
  • Provider type was a significant factor associated with 7-day repeat testing.
  • Further investigation is warranted to understand the drivers of these testing disparities.

Conclusions:

  • Provider experience and training level may influence adherence to CDI testing guidelines.
  • Targeted interventions may be necessary to reduce inappropriate 7-day repeat testing for CDI.
  • Optimizing diagnostic strategies for CDI is crucial for effective patient management and resource utilization.

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