What stool testing is appropriate when diarrhea develops in a hospitalized patient?

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FIGURE 1
Suggested algorithm for evaluation of diarrhea in a hospitalized patient.

TABLE 1

Testing methods for Clostridium difficile-associated diarrhea

Test	Positive predictive value^a	Negative predictive value^a	Cost¹¹	Turnaround time¹¹
Toxigenic culture	94%⁹	98%⁹	$10–30	24–48 hours, up to 9 days
C difficile cytotoxin neutralization assay	93%⁹	97%⁹	$15–25	24–48 hours
EIA for GDH	73%⁹	97%⁹	$15–20	15 minutes
EIA for toxins A and B	70%¹⁰	92%¹⁰	$15–20	15 minutes
Nucleic acid amplification tests	84%¹⁰	99%¹⁰	$25–30	2.5 hours

↵a Positive predictive value and negative predicted value may vary based on specific assay and local prevalence
EIA = enzyme immunoassay, GDH = glutamate dehydrogenase