{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:53:44Z","timestamp":1785408824599,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,23]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":26,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"funder":[{"name":"Hatch Family Foundation"},{"name":"NIDDK\/Harvard Digestive Diseases Center","award":["P30DK034854"],"award-info":[{"award-number":["P30DK034854"]}]},{"DOI":"10.13039\/100000060","name":"NIAID","doi-asserted-by":"crossref","award":["K01AI180357"],"award-info":[{"award-number":["K01AI180357"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/033km2469","id-type":"ROR","asserted-by":"publisher"}]},{"name":"CDC Prevention Epicenters","award":["U54CK000611"],"award-info":[{"award-number":["U54CK000611"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  <jats:italic>Clostridioides difficile<\/jats:italic>\n                  is the leading cause of healthcare acquired infections (HAIs). Healthcare systems lack scalable strategies to identify patients colonized with toxigenic strains to inform prevention programs. We developed a scalable program using rectal swabs, collected for vancomycin resistance Enterococci surveillance, with\n                  <jats:italic>ex vivo<\/jats:italic>\n                  amplification of\n                  <jats:italic>C. difficile<\/jats:italic>\n                  in Cdiff Banana Broth (BB). Optimized confirmatory testing of BB-positive tubes used the rapid\n                  <jats:italic>C. difficile<\/jats:italic>\n                  QuickCheck assay with Cepheid\u2019s Xpert\u00ae C. difficile\/Epi (Xpert) to confirm toxin gene carriage for QuickCheck results of\n                  <jats:italic>C. difficile<\/jats:italic>\n                  glutamate dehydrogenase-positive (GDH) and antigenic toxin-negative. BB with confirmation demonstrated 92% specificity and 100% sensitivity, to a limit of &lt;5 colony forming units (CFU)\/swab, versus published values of 100\/swab by ChromID\u00ae\n                  <jats:italic>C. difficile<\/jats:italic>\n                  agar and 460\/swab by direct Xpert swab testing. The two-step confirmation detected toxigenic\n                  <jats:italic>C. difficile<\/jats:italic>\n                  in cases missed by other methods.\n                <\/jats:p>\n                <jats:p>\n                  Prospective testing of 797 VRE swabs from 538 ICU and inpatient oncology patients seen at an academic medical center and two community hospitals demonstrated 11% positivity for toxigenic and 4% for non-toxigenic C. difficile. Among swabs, 32% of toxigenic\n                  <jats:italic>C. difficile<\/jats:italic>\n                  were resulted at 24 hours and 68% at 48 hours. Addition of 17% glycerol to BB-positive aliquots, for \u201380\u00b0C storage, supported 100% retrieval of\n                  <jats:italic>C. difficile<\/jats:italic>\n                  7 months later. BB with confirmation provides a more sensitive method to detect patient colonization with toxigenic C. difficile and, by using VRE surveillance swabs, does not require additional patient samples. The simplified approach can be deployed across healthcare settings to support\n                  <jats:italic>C. difficile<\/jats:italic>\n                  -prevention programs.\n                <\/jats:p>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>\n                    <jats:italic>C. difficile<\/jats:italic>\n                    infections are the most prevalent HAIs, causing substantive mortality, morbidity, and economic burden. Among HAIs,\n                    <jats:italic>C. difficile<\/jats:italic>\n                    remains the one pathogen lacking scalable surveillance strategies for clinical microbiology labs. We present an optimized strategy to enable\n                    <jats:italic>C<\/jats:italic>\n                    .\n                    <jats:italic>difficile<\/jats:italic>\n                    surveillance testing across broad clinical settings to enable prevention programs for this pathogen.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.22.26358596","type":"posted-content","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T23:25:12Z","timestamp":1784849112000},"source":"Crossref","is-referenced-by-count":0,"title":["Optimized Surveillance Testing for Toxigenic\n                  <i>Clostridioides difficile<\/i>\n                  to Scale Prevention Programs Across Clinical Settings"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9605-1205","authenticated-orcid":false,"given":"LM","family":"Cersosimo","sequence":"first","affiliation":[{"name":"Massachusetts Host-Microbiome Center, Dept. Pathology, Brigham & Women\u2019s Hospital, Harvard Medical School. Boston, MA 02115"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2028-9003","authenticated-orcid":false,"given":"N","family":"Correa","sequence":"additional","affiliation":[{"name":"Massachusetts Host-Microbiome Center, Dept. Pathology, Brigham & Women\u2019s Hospital, Harvard Medical School. Boston, MA 02115"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0138-7345","authenticated-orcid":false,"given":"ML","family":"Delaney","sequence":"additional","affiliation":[{"name":"Massachusetts Host-Microbiome Center, Dept. Pathology, Brigham & Women\u2019s Hospital, Harvard Medical School. Boston, MA 02115"},{"name":"Clinical Microbiology Laboratory, Dept. Pathology, Brigham & Women\u2019s Hospital, Boston, MA 02115"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"DelloStritto","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Misialek","sequence":"additional","affiliation":[{"name":"Department of Pathology, Newton-Wellesley Hospital, Newton, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8641-4498","authenticated-orcid":false,"given":"M","family":"Klompas","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8792-8527","authenticated-orcid":false,"given":"L","family":"Bry","sequence":"additional","affiliation":[{"name":"Massachusetts Host-Microbiome Center, Dept. 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