The usual indication for testing for Clostridium difficile is the new onset of >= 3 unformed stools within 24 hours that cannot be explained or which follows hospitalization or antibiotic therapy.
Infants have a high prevalence of asymptomatic carriage of toxigenic C. difficile. Routine testing for Clostridium difficile is not recommended for pediatric patients less than 2 years of age unless other causes of diarrhea have been excluded.
If the pediatric patient is over 2 years of age then testing for Clostridium difficile is done:
(1) prolonged or worsening diarrhea
(2) one or more risk factors:
(2a) inflammatory bowel disease
(2b) immunosuppressed or immunocompromised
(2c) recent antibiotic exposure
(2d) recent potential exposure to Clostridium difficile
Testing should not be performed:
(1) on formed stools
(2) repeatedly during an episode of diarrhea
