JAMA Diagnostic Test Interpretation 

August 21, 2023

Multistep Testing Algorithms for Clostridioides difficile Infection

Maribeth R. Nicholson, Curtis J. Donskey

JAMA. Published online August 21, 2023. doi:10.1001/jama.2023.15875

Case

A10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms began 5 days after completing a course of amoxicillin for streptococcal pharyngitis. Results of a gastrointestinal pathogen panel that included 18 bacterial, viral, and parasitic pathogens were negative. A stool sample result was positive for Clostridioides difficile by polymerase chain reaction (PCR) testing and an enzyme immunoassay test for C difficile toxin A and B had a negative result.

How Do You Interpret These Test Results?

1. Antibiotic treatment for C difficile infection is not indicated.
2. Antibiotic treatment for C difficile infection is warranted.
3. Stool testing for fecal leukocytes is necessary.
4. The gastrointestinal pathogen panel is likely a false-negative result.