How to Be Smarter About Testing for C. difficile

Belinda Ostrowsky, MD, MPH, Health Systems Director of Epidemiology, Antimicrobial Stewardship & Infection Prevention, Montefiore Medical Center, and Associate Professor of Clinical Medicine, Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, explains how to be more sensible when it comes to testing for Clostridium difficile.

Interview Transcript (slightly modified for readability)

“We don’t really have that many new tests for [Clostridium difficile], but I think what our session [at the Spring 2017 SHEA conference] was trying to discuss is to be more sensible about how we do our testing. We have this notion of antibiotic stewardship where we steward or guide people in the prescribing of antibiotics, but we can also steward people in the testing.

One of the issues is to make sure that we test the right patients. For example, for C. diff, many patients can be colonized, that could have the bacteria on them but not making them sick, and so, if we tested someone that doesn’t have the symptoms of C. diff, they may come up positive, it might force them to be isolated in their room by themselves, and be treated unnecessarily. [It’s important to have] criteria for which patients should be tested, making sure that they have diarrhea, that they’re not retested if they don’t need to be (that would put extra burden on the lab to do extra tests that are not needed), making sure, for example, that we don’t give a patient a laxative—which would promote diarrhea—and have it tested; it might come up positive for C. diff and it might be a falsely positive test.

The other side of that would be making sure that we do timely testing because a patient whose diagnosis is delayed is a patient where we don’t have the opportunity to really give them the appropriate treatment, [and] they may unnecessarily be spreading C. diff to other patients in the environment. So, I think the session was really about how we [can] be smarter about our testing in terms of choosing those patients [to test] and doing really timely testing.”