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Review
. 2020 Aug;33(4):319-326.
doi: 10.1097/QCO.0000000000000653.

Healthcare associated diarrhea, not Clostridioides difficile

Nicholas A Turner  1 , Jennifer L Saullo  1 , Christopher R Polage  2   3
Affiliations
Review

Healthcare associated diarrhea, not Clostridioides difficile

Nicholas A Turner et al. Curr Opin Infect Dis. 2020 Aug.

Abstract

Purpose of review: The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics.

Recent findings: Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications or underlying medical conditions, sometimes Clostridioides difficile, and occasionally viruses. Other infections are rare.

Summary: Clinical assessment remains fundamental to the evaluation of HCAD and targeted testing for C. difficile is sufficient in most patients. Multiplex gastrointestinal panels may have a role in immunocompromised patients but more study is needed. Medication-induced diarrhea is common and underappreciated and not limited to antibiotics, laxatives, and enemas.

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MeSH terms