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Clostridioides difficile, diagnostic testing, heuristics, pediatric colorectal, pediatric surgery nurse practitioner, probabilities



  1. Pasaron, Raquel DNP, APRN, FNP-BC
  2. Calisto, Juan L. MD


Abstract: The purpose of this article is to present an exemplar related to diagnostic testing whereby reasoned decisions can assist the pediatric surgical clinician in the expeditious screening, diagnosis, and management of Clostridioides difficile infection (CDI). In 2017, the Emerging Infections Program for CDI reported that the incidence of healthcare-associated CDI was 9.03 in 100,000 and 26.70 for community-associated CDI in the 1- to 17-year age group. Multistate prevalence data looking at healthcare-associated infections (HCAIs) in acute care hospitals showed that C. difficile was the most common pathogen, causing 12.1% of HCAIs. Given the current trends, defining the pediatric epidemiological characteristics of CDI, which is less common than in adults, is vital. Consequently, clinicians need to know when to suspect CDI; however, classic risks associated with this HCAI are considered to be a moving target leading to challenges in the diagnosis, management, and ability to control the disease. Because the diagnosis of CDI is based on clinical and laboratory findings and precludes management, a sensitive and specific diagnostic test with rapid turnaround time is imperative. The use of probabilities is discussed in the context of the threshold approach in clinical decision making.