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New C Diff Infection Guidelines

Devang Patel, MD and Neda Frayha, MD
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The new IDSA/SHEA practice guidelines on Clostridium difficile infection have a few changes from what we’re used to, mostly about the diagnostic algorithm and first-line treatment options. In this segment, Drs. Devang Patel and Neda Frayha review the new guidelines and how they impact our clinical practice.

 

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Christopher F. -

Thanks for an interesting segment with important updates. I am hoping you can help offer clarity into the recommendations on how to test. The written summary states, "You may start with the toxin assay and if it is negative, you may confirm with a PCR." It is also said in the audio segment around 9 minutes 20 seconds that a negative toxin assay should be followed up with a PCR.

If we started with a toxin assay which was negative, but then we ended up with a positive PCR, how would we know that this was not just colonization?

Maybe the answer is that we're hoping that we're testing the right people so that we would consider a positive PCR would mean infection, but then the question would be why we even bothered to do the toxin assay in the first place.

Can you offer any further explanation to help me understand this?

Thanks!

Chris

Neda F., MD -

Hi Chris. Here's Dr. Patel's reply: "He is correct, we should be testing the correct patient. If they have a positive toxin, a pcr is not necessary. However, if the toxin is negative but index of suspicion is high, pcr can be done.
This should not be necessary on most cases."

Christopher F. -

Hi Neda,

Thanks for following up on that and passing along Dr. Patel's reply. The question then would be if we're testing the correct patients (those who we have a reasonably high clinical suspicion for C. diff) then why bother doing the toxin assay at all if a negative result will just end up with us going to PCR. Is this an issue of the toxin assay being significantly cheaper? Quicker? Available locally at more small hospitals? I can see how if any of those are true then it would still make sense to start with the toxin assay, but I'm not sure which of them might apply. Are you or Dr. Patel able to offer a bit more insight into this?

Thanks!

Chris

Neda F., MD -

Hi Chris. I'll ask and share his thoughts when I hear back. Thanks.

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Retrieve Those Filters Full episode audio for MD edition 170:36 min - 80 MB - M4APrimary Care RAP September 2018 Written Summary-V2 590 KB - PDF

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