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Pediatric Inpatient Clostridium difficile Infection Testing Algorithm

Pediatric Inpatient Clostridium difficile Infection Testing Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


Does the patient have LESS than 3 unexpected liquid/loose stools beyond
their known or established baseline within the past 24 hours?
1, 2, 4
Do NOT Test
Can the diarrhea be the result of the patient currently or recently (past 48
hours) being introduced to a new medication or therapy associated with
diarrhea such as any of the following: stool softeners, laxatives, enemas,
bowel preps, lactulose, tube feeds, narcotic withdrawal or oral contrast?
5
Do NOT Test
Consider altering therapy. Re-evaluate 24+
hours after suspending affecting agent-
especially purgatives. If agent cannot be
suspended, exercise clinical judgment and if
appropriate proceed to the next (“No”) step
below.
Yes
No
Did the diarrhea resolve/improve on its own prior to testing? Has the
order been placed and the specimen unable to be collected/obtained for
more than 8 hours?
Yes
Do NOT Test. If the order is placed and > 8
hours elapsed without bowel movement,
discuss with ordering provider. Remove
patient from isolation if infectious diarrhea is
no longer suspected.
No
ORDER the Test
Continue enhanced contact isolation.
Do not test for cure.
In the FIRST 48 hours of admission (patient age > 3 years)*
Does the patient complain of or have any unexplained loose stools
prior to admission? This includes pediatric patients with known
inflammatory bowel disease experiencing diarrhea.
Do NOT Test
No
AFTER 48 hours following admission (patient age > 3 years)*
Yes
No
DISCLAIMER:
Laboratory limit: 1 Test every 7 days.
Complex patients, including obstruction cases and
patients with inflammatory bowel disease may not
readily conform to this algorithm. As always, sound
clinical judgement should be applied in conjunction with
the information provided here. In some instances,
expert opinion should be solicited.
Pediatric Inpatient PCR Testing Algorithm for Clostridium difficile infection (CDI)
Place on enhanced contact isolation.
Strongly consider testing.
Yes
Place patient on enhanced contact isolation. Maintain isolation until
diarrhea resolves or an alternative, non-infectious cause of diarrhea has
been determined.
Last Revised: 5/27/2016
Clostridium difficile – Pediatric/Adult – Inpatient/Ambulatory Guideline
References. (7-11 peds specific)
1.Surawicz CM, et al. Am J Gastroenterol. 2013 Apr;108(4):478-98.
2. Peterson, LR, Robicsek A. Ann Intern Med 2009; 151:176-179.
3. http://www.wakehealth.edu/uploadedFiles/User_Content/SchoolOfMedicine/Departments/CAUSE/
PPT_and_PDF_files/CDI%20Decision%20Support%20Tree%20Algorithm%20-%2006%2026%2014.pdf
4. Cohen S. et al Infect Control Hosp Epidemiol. 2010 May;31(5):431-55.
5. Brazier JS. J Antimicrob Chemother1998; 41
6. Bagdasarian N, Rao K, Malani PN. JAMA. 2015;313(4):398-408.
7. http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2013.441
8. http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16941358
9. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/
landingpage.htm?issn=0891-3668&volume=30&issue=7&spage=610
10. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/
landingpage.htm?issn=0891-3668&volume=30&issue=7&spage=580
11. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/
landingpage.htm?issn=0891-3668&volume=34&issue=9&spage=919
NOTE: During 18 recent months at UW 79% of the 47 pediatric patients with CDI
were identified in clinic, the emergency department or within the first 48 hours of
admission. In a recent study, 23% of community onset pediatric cases had no risk
factors for CDI (5). Do not test asymptomatic patients but thoroughly evaluate GI
symptoms on admission and consider CDI early on as a potential causative
pathogen in symptomatic patients.
* Because of the high prevalence of asymptomatic carriage
of toxigenic CDI in infants and young children up to 3 years
of age, routine testing for CDI is not recommended. If
completed it should be conducted with testing for
alternative causes of diarrhea, such as norovirus and
rotavirus. CDI should not be assumed to be causative of
diarrhea unless there is no other plausible explanation.
Testing should NOT be completed in patients younger than 3 years of age.*
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org