title: Testing for Clostridium difficile in patients newly diagnosed with inflammatory bowel disease in a community setting.
abstract: BACKGROUND
  The incidence of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) is increasing, and CDI has a negative impact on IBD outcomes with both increased morbidity and mortality. Data are lacking regarding the rate of appropriate testing for CDI at the time of diagnosis.
  
  
  METHODS
  We sought to determine the rate of CDI testing and CDI positivity at diagnosis of IBD using data collected through the Ocean State Crohn's and Colitis Area Registry (OSCCAR), a prospective cohort of patients with newly diagnosed IBD. CDI testing and CDI positivity were determined by reviewing the medical records of patients enrolled into the registry and diagnosed with IBD between January 2008 and July 2011.
  
  
  RESULTS
  Of 320 enrolled patients, 227 (70.9%) reported diarrhea, and CDI testing was performed for 113 (49.8%) of the 227 patients. CDI testing was not recorded as being performed for the remaining 114 patients who reported having diarrhea. An additional 24 patients were tested for CDI but did not report having diarrhea. Seven (5.1%) of the 137 patients tested for CDI were positive.
  
  
  CONCLUSIONS
  Testing for CDI is significantly lower than expected at diagnosis of IBD. Although the prevalence of CDI among tested patients is approximately 5%, a low testing rate suggests a significant quality issue in the diagnosis of IBD, with the potential for delayed diagnosis of CDI.
authors.affiliation: *Department of Medicine, Division Gastroenterology, Alpert Medical School, Brown University, Providence, Rhode Island; †Department of Medicine, Rhode Island Hospital, Providence, Rhode Island; ‡Division of Pediatric Gastroenterology, Hasbro Children's Hospital, Providence, Rhode Island; §Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; and ‖Crohn's & Colitis Foundation of America, New York, New York.
authors.forename: Anita
authors.initials: A
authors.lastname: Krishnarao
authors.forename: Lauren
authors.initials: L
authors.lastname: de Leon
authors.forename: Renee
authors.initials: R
authors.lastname: Bright
authors.forename: Heather
authors.initials: H
authors.lastname: Moniz
authors.forename: Meaghan
authors.initials: M
authors.lastname: Law
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
authors.forename: Marjorie
authors.initials: M
authors.lastname: Merrick
authors.forename: Jason
authors.initials: J
authors.lastname: Shapiro
authors.forename: Sylvan
authors.initials: S
authors.lastname: Wallenstein
authors.forename: Julie
authors.initials: J
authors.lastname: Giacalone
authors.forename: Samir A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D055815:Young Adult