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Diagnostic Stewardship Approaches to Clostridioides difficile Infection in the Era of Two-Step Testing: a Shifting Landscape

  • Microbial Stewardship (M Stevens, Section Editor)
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Abstract

Purpose of review

To discuss the current strategies and impact of diagnostic stewardship for Clostridioides difficile infection.

Recent findings

The diagnosis of C. difficile infection is challenging due to complex epidemiology and the limitations of a single assay that is adequate for diagnosis. Overdiagnosis with sensitive molecular assays is common due to the prevalence of colonization with C. difficile. To overcome these challenges, multiple diagnostic stewardship strategies have been successfully deployed to optimize C. difficile testing.

Summary

Diagnostic stewardship strategies should be implemented at every stage of C. difficile testing in order to limit testing to patients with a high pre-test probability, minimize the limitations of stand-alone assays, and guide clinicians to appropriate management through clear result reporting and interpretation.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University Medical Center, VMI Building, 2nd Floor, Room 205, Richmond, VA, 23298, USA

    Jennifer Emberger MD, MPH, Matthew M. Hitchcock MD, MPH & J. Daniel Markley DO, MPH

  2. Department of Medicine, Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    Matthew M. Hitchcock MD, MPH & J. Daniel Markley DO, MPH

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  1. Jennifer Emberger MD, MPH
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Emberger, J., Hitchcock, M. & Markley, J.D. Diagnostic Stewardship Approaches to Clostridioides difficile Infection in the Era of Two-Step Testing: a Shifting Landscape. Curr Treat Options Infect Dis 12, 258–274 (2020). https://doi.org/10.1007/s40506-020-00223-8

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