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Related Experiment Video

Updated: Jun 5, 2026

Cefoperazone-treated Mouse Model of Clinically-relevant Clostridium difficile Strain R20291
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Clostridiodes difficile Testing Protocol: An Effective Strategy to Decrease Over-Testing Patients for C. difficile

Sneha Kalluri1, Daniel Cain2, Abishek Volety2

  • 1Internal Medicine, Texas Health Resources Denton, Denton, USA.

Cureus
|October 27, 2025
PubMed
Summary

This study shows a new protocol effectively reduces unnecessary Clostridioides difficile infection (CDI) testing, avoiding false positives while maintaining high accuracy for true CDI cases.

Keywords:
adult gastroenterologyclostridioides difficile infectiondiarrheal illnessgastroenterologyinfectious diseasequality improvement studyresource allocationstool specimen

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Healthcare Quality Improvement

Background:

  • Symptomatic diarrhea often prompts Clostridioides difficile infection (CDI) testing.
  • Increasing false positive results lead to unnecessary resource utilization and physician skepticism towards diagnostic protocols.
  • Physicians may over-order CDI tests due to concerns about protocol negative predictive value.

Purpose of the Study:

  • Evaluate an implemented screening test protocol's efficacy at Baylor Scott & White All Saints Medical Center.
  • Assess the protocol's ability to mitigate overuse of hospital testing resources.
  • Determine the protocol's effectiveness in triaging true CDI cases and its negative predictive value (NPV).

Main Methods:

  • Retrospective, observational study analyzing C. difficile testing.
  • Data collected from January 1, 2021, to January 1, 2022.
  • Evaluation of a diagnostic stewardship protocol for CDI testing.

Main Results:

  • Out of 443 initial C. difficile tests, 391 were canceled by the protocol.
  • Of 52 tests performed, 7 were positive and 45 negative for C. difficile.
  • The protocol demonstrated a negative predictive value of 96.82% (365/377 true negatives).

Conclusions:

  • The protocol effectively prevents false positive CDI results and avoids missing true positives.
  • The diagnostic stewardship protocol shows excellent negative predictive value.
  • This quality improvement initiative is suitable for implementation in other hospitals.