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4 Figure 1. CDI Laboratory Test Recommendations Based on Pre-Agreed Institutional Criteria for Patient Stool Submission Clinicians and laboratory personnel agree at the institutional level not to submit stool specimens from patients receiving laxatives and to submit stool specimens only from patients with ≥3 unexplained and new onset unformed stools in 24 h for testing for CDI. Stool toxin test a as part of a multiple step algorithm (i.e., GDH plus toxin; GDH plus toxin, arbitrated by NAAT; or NAAT plus toxin) rather than a nucleic acid amplification test (NAAT) alone. a Approved stool enzyme immunoassay (EIA) toxin tests vary widely in sensitivity. Laboratories should choose a toxin test with sensitivity in the upper range of sensitivity as reported in the literature. NAAT alone OR stool toxin test a as part of a multiple step algorithm (i.e., GDH plus toxin; GDH plus toxin, arbitrated by NAAT; or NAAT plus toxin) rather than a toxin test alone. YES NO Diagnosis

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