From the Guidelines
It is appropriate to not collect a C. difficile sample from this patient. The patient is currently on bowel prep for a colonoscopy and has post-colonoscopy bleeding, which can alter stool consistency. C. difficile testing should be avoided in patients on laxatives or bowel prep as these can cause diarrhea that mimics C. difficile infection, leading to false positive results 1. Additionally, the altered gut flora during bowel preparation can affect test accuracy. The protocol likely triggered automatically based on the patient's loose stools, but clinical judgment should override this when there's a clear alternative explanation for diarrhea.
Instead, monitor the patient's bleeding and reassess for C. difficile testing only if diarrhea persists after the effects of bowel prep have resolved (typically 2-3 days) and if there are other clinical indicators of infection such as fever, abdominal pain, or leukocytosis. This approach is supported by guidelines that recommend diagnosing C. difficile infection based on clinical signs and symptoms in combination with laboratory tests, and considering the clinical context and background prevalence of C. difficile in the institution 1.
The diagnosis of C. difficile infection should be suspected in patients with acute diarrhea with no obvious alternative explanation, particularly in the setting of relevant risk factors such as recent antibiotic use, hospitalization, and advanced age 1. However, in this case, the patient's current condition and treatment provide an alternative explanation for the diarrhea, making it unnecessary to collect a C. difficile sample at this time.
It's also important to note that repeat testing after a first negative sample during the same diarrheal episode is not recommended in an endemic situation, but may be useful in an epidemic situation 1. In this case, since the patient's diarrhea can be explained by the bowel prep and post-colonoscopy bleeding, repeat testing is not necessary unless the patient's condition changes or other clinical indicators of infection appear.
In summary, not collecting a C. difficile sample from this patient is the most appropriate course of action, given the current clinical context and the potential for false positive results due to the patient's bowel prep and post-colonoscopy bleeding.
From the Research
Patient Situation
The patient is experiencing post-colonoscopy bleeding and is currently on bowel prep, which triggered a C diff collection per protocol.
Relevant Studies
- The provided studies 2, 3, 4, 5, 6 focus on the treatment of Clostridioides difficile infection (CDI) using various methods such as fidaxomicin, vancomycin, and fecal microbiota transplantation (FMT).
- These studies do not directly address the situation of a patient experiencing post-colonoscopy bleeding who has triggered a C diff collection per protocol.
C Diff Collection Protocol
- There is no direct evidence in the provided studies to support or refute the decision to collect a C diff sample in this specific situation.
- The studies primarily focus on the treatment of CDI, rather than the protocol for collecting C diff samples in patients with post-colonoscopy bleeding.
Key Points to Consider
- The patient's current condition and the triggered C diff collection protocol should be evaluated by a healthcare professional to determine the best course of action.
- The decision to collect a C diff sample should be based on the patient's individual needs and the clinical protocol in place.
Treatment Options for CDI
- The provided studies suggest that fidaxomicin, vancomycin, and FMT are potential treatment options for CDI, but the choice of treatment depends on various factors, including the severity of the infection and the patient's medical history.
- The studies 2, 3, 4, 5, 6 provide evidence on the effectiveness of these treatment options, but do not directly address the situation of a patient with post-colonoscopy bleeding who has triggered a C diff collection per protocol.