Clostridioides Difficile Infection Testing Patterns and Outcomes Following Laxative Administration


A study, presented at the Society for Healthcare Epidemiology of America (SHEA) conference, assesses laxative administration before CDI testing in Veteran Affairs (VA) hospitals and explores the demographic and contextual factors with non-adherence to guidelines.

Clostridioides difficile virus

Image Credits: Unsplash

Clostridioides difficile virus

Image Credits: Unsplash

Clostridioides difficile infection (CDI) remains a major healthcare challenge, causing around 500,000 infections and 30,000 deaths each year in the US. Despite guidelines that recommend against testing for CDI shortly after laxative use to avoid misdiagnoses, this practice is often ignored.

In an analysis of 7,326 tests for 4,888 patients at VA Medical Centers in Illinois, Wisconsin, and Michigan, the results reveal significant adherence issues. Most of the patients tested were White (61.8%) and male (95.6%), with an average age of 70 years. Notably, about 59% of the tests were conducted within 48 hours of laxative use. Black and Hispanic patients were less likely to undergo guideline-noncompliant testing compared to White patients. Tests from rural facilities, long-term care units, and intensive care units showed a higher occurrence of non-adherent testing. Tests not following guidelines more frequently resulted in negative outcomes.

This pattern aligns with results from non-VA studies, showing widespread non-compliance with CDI testing guidelines, particularly in settings such as ICUs and long-term care facilities. The noted racial disparities in testing practices suggest a potential area for improving adherence to guidelines.

This retrospective cohort study focused on adults admitted to VA Medical Centers from January 2019 to December 2022 who underwent CDI testing. The tests used were Toxin B gene Polymerase Chain Reaction or Toxin Enzyme Immunoassay. Data on laxative use, demographics, admission details, and comorbidities were extracted from the VA Corporate Data Warehouse. Testing that did not adhere to guidelines was defined as a CDI test ordered within 48 hours following laxative use. Factors influencing non-adherent testing were analyzed using clustered binomial logistic regression, and statistical analyses were conducted using SAS 9.4.

Further research is needed to explore the implications of inappropriate testing, which includes unnecessary treatments and increased healthcare costs. It is recommended that diagnostic stewardship be prioritized to enhance compliance with CDI testing guidelines across VA hospitals.


Geneva Wilson, PhD. High Prevalence of Laxative Use Among Those Tested for Clostridioides difficile Infection in VA Hospitals. Poster #94 presented at SHEA 2024. April 16-19, 2024. Houston, TX.

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