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Adult Inpatient Clostridium difficile Infection Testing Algorithm

Adult 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, or
oral contrast?
Do NOT Test
Consider altering therapy. Re-evaluate 24-48
hours after suspending affecting agent. If agent
cannot be suspended, exercise clinical
judgment and if appropriate proceed to the
next (“No”) step below.
Is the patient low-risk (i.e. afebrile, no elevated WBC, no abdominal pain,
no recent antibiotic use, not an IBD patient nor any recent/frequent
healthcare encounters)?
Do NOT Test
Pre-test probability is low. Consider
alternative causes of diarrhea.
ORDER the Test
Continue enhanced contact
Do not test for cure.
In the FIRST 48 hours of admission
Does the patient complain of or have any unexplained loose
stools prior to admission?
Do NOT Test
AFTER 48 hours following admission
DISCLAIMER: Laboratory limit: 1 Test every 7 days.
Complex patients, including obstruction cases, 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.
Adult Inpatient Testing Algorithm for Clostridium difficile Infection (CDI)
ORDER the Test
Place on enhanced contact isolation.
Place patient on enhanced contact isolation. Maintain isolation until
diarrhea resolves or an alternative, non-infectious cause of diarrhea has
been determined.
Last reviewed/revised: 07/2016
Contact CCKM for revisions.
Clostridium difficile – Pediatric/Adult – Inpatient/Ambulatory Guideline
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/
4. Cohen S. et al Infect Control Hosp Epidemiol. 2010 May;31(5):431-55.
5. Brazier JS. J Antimicrob Chemother1998; 41
6. http://www.uptodate.com/contents/clostridium-difficile-in-adults-treatment
7. Bagdasarian N, Rao K, Malani PN. JAMA. 2015;313(4):398-408.
NOTE: It is important to consider whether the diarrhea could be a result of recent or overuse of
medications or therapies associated with diarrhea including: stool softeners, laxatives, enemas,
bowel preps, etc. Further, more than 55% of positive CDI tests are in clinic or on admission to
UW Health suggesting CDI is more common in the community than traditionally believed. 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
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org