{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:16:07Z","timestamp":1781644567895,"version":"3.54.5"},"reference-count":10,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,9,12]]},"abstract":"<jats:p>A 10-year-old girl with spina bifida and neurogenic bowel hospitalized for abdominal pain, dehydration, and more than 20 episodes of diarrhea per day. A stool sample test result was positive for <jats:italic>Clostridioides difficile<\/jats:italic> by polymerase chain reaction and an enzyme immunoassay result for <jats:italic>C difficile<\/jats:italic> toxin A and B was negative. How do you interpret these test results?<\/jats:p>","DOI":"10.1001\/jama.2023.15875","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T15:32:20Z","timestamp":1692631940000},"page":"966","source":"Crossref","is-referenced-by-count":11,"title":["Multistep Testing Algorithms for <i>Clostridioides difficile<\/i> Infection"],"prefix":"10.1001","volume":"330","author":[{"given":"Maribeth R.","family":"Nicholson","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Donskey","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"jdt230002r1","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1016\/S1473-3099(13)70200-7","article-title":"Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C difficile infection.","volume":"13","author":"Planche","year":"2013","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"jdt230002r2","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/cix1085","article-title":"Clinical practice guidelines for clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).","volume":"66","author":"McDonald","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"jdt230002r3","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.1016\/j.cmi.2016.03.010","article-title":"European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection.","volume":"22 Suppl 4","author":"Crobach","year":"2016","journal-title":"Clin Microbiol Infect"},{"issue":"6","key":"jdt230002r4","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections.","volume":"116","author":"Kelly","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"jdt230002r5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad332","article-title":"Is the healthcare facility level sufficient for assessing the impact of two-step Clostridioides difficile testing?","author":"Gerding","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"3","key":"jdt230002r6","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1097\/MPG.0000000000002944","article-title":"Two-step testing for Clostridioides difficile is inadequate in differentiating infection from colonization in children.","volume":"72","author":"Parnell","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"4","key":"jdt230002r7","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1093\/cid\/ciy701","article-title":"Frequency of positive enzyme immunoassay for toxin in stool of asymptomatic carriers of Clostridium difficile.","volume":"68","author":"Ng Wong","year":"2019","journal-title":"Nephrol Dial Transplant"},{"issue":"11","key":"jdt230002r8","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.1001\/jamainternmed.2015.4114","article-title":"Overdiagnosis of Clostridium difficile infection in the molecular test era.","volume":"175","author":"Polage","year":"2015","journal-title":"JAMA Intern Med"},{"key":"jdt230002r9","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.313","article-title":"Real-world evaluation of a two-step testing algorithm for Clostridioides difficile infection.","author":"Hecker","year":"2023","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"jdt230002r10","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01764-19","article-title":"Predictors of Clostridioides difficile infection-related complications and treatment patterns among nucleic acid amplification test-positive\/toxin enzyme immunoassay-negative patients.","volume":"58","author":"Miller","year":"2020","journal-title":"J Clin Microbiol"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2808795\/jama_nicholson_2023_dt_230002_1694462928.92205.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T15:05:19Z","timestamp":1694531119000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2808795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,12]]},"references-count":10,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,9,12]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2023.15875","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9,12]]}}}