About 10% of patients with diarrhea will test positive for CDI. Around 2% of ICU patients develop an episode of CDI. Estimating the severity of CDI is essential for prognosis and therapy. Diagnosis and estimation of disease severity and progression are even more complicated in the ICU setting and should be assisted by clinical prediction tools (i.e., ATLAS score). Current diagnostic algorithms may lead to an underestimation of CDI severity in ICU patients. Testing should include direct toxin testing by ELISA. We do not consider the isolated detection of C. difficile via PCR sufficient to make the diagnosis of CDI.

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