Test stewardship is an evolving topic in the medical literature. I recently wrote about test stewardship with respect to urine cultures and CAUTI rates.Now, as reported here, computerized clinical decision support tools in the EMR can assist in reducing inappropriate C. difficile. Given that nucleic acid amplification tests can be overly sensitive and that C. difficile is part of the normal bowel flora, we are still looking for the 'right test at the right time' to make the diagnosis. A magic 'diagnostic' bullet of sorts.
In the above referenced paper, C. difficile test stewardship decreased inappropriate C. difficile testing, specifically, not testing patients with diarrhea while on laxatives. No significant harm was reported. This is not salvation but at least a step forward in not over diagnosing hospital onset C.difficile. So I say, press on with such interventions (which we are doing at VCU).
Clostridium difficile infections in the hospital continue to vex us, largely because the extent to which they are preventable is highly debatable, as explored here.
With the current state of science, solving our C. difficile problem is much like solving world inequality.
