The Microbiology laboratory at South West London Pathology (SWLP) is now following advice set out in the UK Standards for Microbiology Investigation for the investigation of faecal specimens for Clostridioides difficile (UKHSA) regarding criteria for C. difficile testing.
This guidance has been updated as half of community CDI cases may be undetected because of an absence of clinical suspicion, accounting for three times more undiagnosed adults in the community compared with hospitals in one study1.
Therefore, as a minimum the following community patients will be tested even if not clinically suspected or requested. The laboratory will add on C. difficile testing where clinical details include the following criteria:
- all community patients ≥ 65 years old
- community patients < 65 years old when specifically requested and in situations specific to the following:
- if C. difficile is mentioned in request clinical details
- if the patient is recognised by the testing laboratory, microbiologists or IPC team as previously having C. difficile.
- if current or prior antibiotic therapy is mentioned
- if a hospital admission is mentioned
- if residence at a care home or other community care facility is indicated by the patient address, or mentioned on the request form
- immunocompromised (e.g., transplant patients, patients on chemotherapy)
- inflammatory bowel disease (IBD, eg, Crohn’s disease or Ulcerative Colitis)
- recent abdominal surgery
- chronic renal/kidney disease (CKD)
- if clinical details indicate patient has been prescribed a proton pump inhibitor (PPI; eg lansoprazole, omeprazole)
If you would like to discuss this, please email SWLPComms@stgeorges.nhs.uk.
References
- Viprey VF and others. A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018. Euro Surveill 2022: volume 27, issue 26.2++ 10.2807/1560 7917.Es.2022.27.26.2100704