Laxative use and testing for Clostridium difficile in hospitalized adults: An opportunity to improve diagnostic stewardship

Frequency of stool specimen collection and testing for Clostridioides difficile of hospitalized adults and long-term care facility residents with new-onset diarrhea in Louisville, Kentucky

“…Rather, White and colleagues found that patients with or without laxative use within 48 h before diagnosis had similar rates of severe CDI and CDI-attributable clinical outcomes ( White et al, 2020 ). In addition, laxative use itself is often linked to risk factors, such as surgery and hospitalization, that increase the risk of CDI ( Carter and Malani, 2019 ). Other noninfectious causes of diarrhea, including feeding tubes and inflammatory bowel disease, have also been shown to predispose patients to CDI ( Martinelli et al, 2014 ;O'Keefe, 2010 ).…”

The impact of changing reflexive to clinician-ordered Clostridioides difficile polymerase chain reaction (PCR) testing for indeterminate cases: Cost savings without associated adverse events

“…10 Common inpatient causes of diarrhea include medications (antibiotics and laxatives) and tube feeding. 11 Because asymptomatic colonization with C. difficile is common (3%-26% depending on patient characteristics including healthcare exposures), overuse of PCR testing for C. difficile often detects asymptomatic colonization rather than true disease. 4,12,13 The overdiagnosis of CDI has several potential negative consequences: (1) falsely ascribing a clinical scenario (eg, elevated white blood count [WBC]) to CDI and missing other causes; (2) unnecessary CDI treatment leading to avoidable antibiotic-related adverse effects such as drug interactions, side effects, increased risk of colonization with multidrug-resistant organisms, and disruption of intestinal microbiota 14,15 ; (3) increased healthcare costs (antibiotic use and isolation); (4) stigma; and (5) potential reduced healthcare time with the patient due to enhanced contact isolation.…”