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Discussion

re-testing stool after c-diff tx

I work in a nursing home/sub-acute rehab but I figured everyone could probably offer input or feedback.

We just had a resident complete 2 rounds of ABT for c-diff. He completed a 14-day round of Flagyl and was still having loose stool. A C&S was obtained and send to the lab. The culture came back positive for c-diff antigen and toxin. The result was called into the MD and he started the resident on Vancomycin for 14 days. It seems that no one ever received or called in the sensitivity results to the MD. The resident just completed the course of PO Vanco QID x 14 days last week and is still having loose stool. By chance, we discovered the sensitivity from the stool obtained at the beginning of September for this resident. I called the MD with results, and of course the sensitivity said the c-diff was resistant to Vanc. The MD ordered to re-start the resident on Flagyl, with no specified stop date for treatment. Apparently I wasn't clear enough that the sensitivity had been obtained after he started the Vanc but not after he had completed it. No final C&S had been obtained after he completed the Vanc.

The resident was restarted on Flagyl but when the MD discovered that even though he was resistent to the Vanc, he completed the course of ABT and got better, so we were just supposed to leave it at that, regardless of the sensitivity that came back after it had been ordered. The MD d/c'ed the Flagyl and there are no new orders at this point. No C&S, nothing. Apparently, it's common practice to not test stool after completing a course of ABT to see if the resident still has c-diff unless they're symptomatic, which he was, but that wasn't made 100% clear to the MD.

Doc is now pitching a fit and things are going up the food chain to the DON and the Medical Director.

Do any of y'all have a policy of re-testing stool after completing ABT for c-diff?

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    The lab is usually the one who has policies on testing and re-testing.

    I would think that you will have to be on contact precautions with this patient until the C-diff is negative.

    I would make it clear to the MD that the patient is still symptomatic. And discuss what he is sensitive to, and see if you can start that.

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    Frankly, if the C. Diff is resistant to Vancomycin and the MD is relying on Flagyl - y'all are probably up a creek anyhow.

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    Sounds like another case of the ball being dropped and the MD getting no real clear picture about what's going on. We only retest if the patient is still symptomatic.

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    Frankly, if the C. Diff is resistant to Vancomycin and the MD is relying on Flagyl - y'all are probably up a creek anyhow.

    Oh yeah and I guess the doc forgot, this resident was on Flagyl FIRST for c-diff and after completing 14 days, he became symptomatic again and THEN went on the Vanc.

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    Our policy is to retest 48 hours after last dose of antibiotics.

    From the research and recommendations I have seen though, there isn't any one clear cut guideline/ recommendation on this currently.

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    • Author
    Our policy is to retest 48 hours after last dose of antibiotics.

    From the research and recommendations I have seen though, there isn't any one clear cut guideline/ recommendation on this currently.

    I'm glad to hear that you have a policy. Is it under the Department of Medical Services, Laboratory, of Nursing? Any chance you have access to an electronic copy/PDF?

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