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Two-step diagnostic approaches to Clostridioides difficile infection (CDI) comprising PCR-based nucleic acid amplification testing (NAAT) followed by toxin testing are increasingly common, with the rationale of directing CDI therapy only at patients with diarrhea who will benefit from such therapy. However, uncertainty exists in clinical practice regarding treatment of NAAT+/toxin− patients with diarrhea who are at high risk for CDI.
In a retrospective study involving 632 patients (median age, 61; 50% immunocompromised), Hogan et al. examined outcomes across two periods where two-step CDI testing was performed but only one result was reported. For the preintervention period, only NAAT results were reported; for the intervention period, only …