Collecting stool sample for c.difficile

[whitepine]

Hi all!

Quick question! When collecting your stool samples, what protocol do you normally follow. I collected mine on Friday night and was told to freeze it, and bring it to the lab on Monday (today)

Just checking in to make sure that freezing it is okay.
I am 30 days off vanco and all meds, also 30 days since my infusion, finally got diarrhea on Friday and collected the sample. GI said only test if it was liquid stool.

Making sure it's ok to freeze it.
Thank you! :)

[Sheila1]

Quest Labs says to freeze it if it can't be brought in right away. Most prefer liquid stools, however, I tested positive twice with just soft stools.

[Christina]

By now you've probably dropped off your samples or are going to but I wanted to add that like Sheila, all of my 8 positives were on softer stool rather than the pure diarrhea. When I would relapse I had intermittent soft stool and pure bloody diarrhea. I was never able to catch any of the real bad watery stuff. Also, yes freezing works and is protocol if you can't get to the lab right away. When I had to ship samples up to Chicago to Dr.Gerding I collected them on Saturday,froze them, and then on Monday had to overnight them to his lab. They got there on Tuesday and whenever they tested them I don't know but, 2 out of 2 tested positive and both grew the c-diff bacteria.

[whitepine]

Thank you both!

I dropped them off at Quest this morning, says it will take 3 days. I feel just awful, super nauseated. For me, all my soft stools have been negative, it's only when it's watery diarrhea that I get a positive. Thanks for the info, glad to know freezing is ok. I had to stop the Elavil, even at 10 mg at night it made me so hungover like a zombie and nauseated even worse.
Hanging in there!

:-) Hugs!

[Nan]

Good to know that freezing is OK.

I have a couple of questions on getting a stool sample.

Do you always have to use those small sterile containers? I was just wondering if I needed to bring in a sample and didn’t have one, what is best to use?

And do any of you have a preferred method of “collecting” the sample that works best? I struggle with getting a sample.

Hang in there Whitepine.

[Christina]

Your sample should always be in a sterile specimen cup. I ordered a box of 30 and keep them in a closet that way I always have them on hand.I ordered them from a company Craig Medical Distribution in CA. If you order them make sure they are the sterile ones wrapped individually in plastic. They sell both.

As far as collecting, I always used a piece of Saran Wrap and laid it across the bowl under the seat then used a plastic spoon to get the sample in the container. I then flushed what was left and threw everything I used into a trash bag and directly outside into my trash bin. I also always wore disposable rubber gloves as well and always had the bleach handy.

[Nan]

Thanks Christina. I’ll have to order some of those sterile cups. And good info on collecting. As I mentioned, I have struggled with that. And as an aside, I have had positive with soft stool. Too sick to even try with the watery stuff, and lucky to make to the toilet, sometimes.

I wonder if toxins are in the mucous or does a sample need stool too?

[Christina]

I have a friend who turned in just mucous and got a positive. I think someone else on the site has as well. I've never tried it and always waited until I could get stool.

[Bobbie]

Thx. for info., Christina. Posted it in FAQ-Tests.

[izzy]

I am being tested for the first time for C. Diff. My doctor immediately suspected this due to multiple antibiotics, including Clindamycin for MRSA infection from hospital stay. I have read extensively about C. Diff. and the symptoms my symptoms are very indicative. My concern is that I was not told to freeze or refrigerate my samples. I had three cylindrical vials that I had to add stool to a liquid chemical, and one tube with a "q-tip" on one end and a gel that you inserted the q-tip into. I was able to get a soft sample at 7:30 a.m.and add it to the vials/tube , but was not able to get the sample to the lab until 2:00 p. m.

Also, at about 2:15 I had a few bouts of liquid diarrhea (quite different from the sampled stool) and was curious if there is a consensis about which type of stool is best for testing.

I am also concerned that my doctor was going to just put me on Flagyl without testing until I told him about the blood and my family history of ulcerative colitis and peptic ulcer disease. They didn't order the stool sample until I asked about controlling the diarrhea and that I had read that anti-diarrhea meds are not recommended until C. Diff is ruled out due to the toxins and being kept in the bowel longer.

Unrelated technical question: What is BBCode? There were several terms I encountered when registering that I was not familiar with.

[Sheila1]

izzy,

Most labs prefer the liquid, or at least non-formed, stool. But myself, and others, have tested positive with a soft stool, or even just mucous. In most cases if you are very sick the toxins will be in whatever is produced (it is the actual toxins that make you sick, not the bacteria itself); but there are still a high number of false negatives. If symptoms are indicative of cdiff and you get a negative, ask to do another test - 3 days in a row is best if you feel sure you have it and do get a false negative (see FAQ's, Tests). Be sure they are testing for both toxins A and B.

I have also tested positive when my sample had been left out for several hours, but it was just as likely I could have gotten a false report by doing so (it was before I knew to freeze it). By not freezing or refrigerating it can effect the results; particularly toxin B as it breaks down very rapidly. So if a person was toxin A- and B+, you could test a 'false' negative if the B had broken down already (this, added to the general 20-30% false negative factor, makes the false rate quite high in this case). I've also gotten positive results using anything from sandwich baggies to butter bowls....but this too could have effected the results, I was just fortunate it didn't. Anything we use to obtain the sample is generally not a sterile item but it is supposed that there is less adverse effects with temporary contact vs. stored, and longer, contact with non-sterile containers.

For best possible results do as instructed in "Tests" - sterile container, refrigerate or freeze and get it to the lab asap.

Hope you're feeling better soon!

[Christina]

The samples I sent to Chicago were the only ones I froze and/or refrigerated. My Dr.'s protocol for me to follow was always to collect the sample and get it to the lab room temp. within in hour or throw it out and that is what I always had followed.I use the hospital lab so it was open 24/7. Once while in Boston I relapsed and I did wait 2 hours as I had to drive myself into town in traffic and still got a positive result.
I had 8 positives out of 11 relapses following this procedure. Two of those were not tested and one was a false negative. The false negative was my fault though so I can't blame anyone but myself and I knew it would turn out negative.
Normal protocol is to refrigerate or freeze but in my opinion it all depends on how long you allow it to sit. Unfortunately, we can't control how the labs handle them. Once it's in their hands we have to put our trust in them. Easier said than done! Do beware that labs make mistakes, they are only human. One of my tests came back negative and they called it into my Dr.. The next day they called him back only to say who ever read the test had done so incorrectly and when the supervisor reread it it was actually positive. It was a good thing I never,ever had to wait for the lab results and had already restarted my Vanco.

[izzy]

Thank you for the information and support. I am scheduled for a colonoscopy this Thursday. Does anyone know if the test they perform during the colonoscopy is more or less accurate than the stool test? If less accurate, I will request the 3 day stool test and be sure to freeze samples if I can't get directly to the lab. Also, the lab I go to sends the samples off for analysis. Is this bad? I am considering going to Atlanta or Birmingham for more healthcare options.

Thanks again.

[Sheila1]

izzy,

The first thing they'll look for in the colonoscopy is pseudomembranes, but not everyone gets the psuedomembranous colitis with cdiff. It's not a matter of accuracy - you can still have cdiff with the colonoscopy appearing normal (this is the case more often than not).

They'll also look for the things you indicated in family history and they'll probably take a biopsy to check for microscopic colitis, and other routine things.

Alot of labs (all of them in my area) have to overnight things to a main, more specialized lab. I read (somewhere!) that 3 days is max, even frozen, before a sample wasn't reliable anymore.

I'd probably wait and see what this first sample result is. Then see what the colonoscopy result shows. If all are negative, then maybe ask the doc for the 3-day test if I still believed cdiff was the problem.

Have you been tested for the other common things like parasites, etc. that also cause similar symptoms? While we hate to even consider the possibility, it is very common, especially given that people love dogs and cats...many of which have parasites that can be transferred to humans. Here's a site on parasites if you've the stomach for it (tic):
http://www.appliedozone.com/parasites.html

Other commonly tested diseases are Shigella, Campylobacter, Yersinia, Aeromonas, Plesiomonas, E. Coli. etc.

Just a thought -

[Christina]

Prior to my first colonoscopy my stool test for c-diff and parasites,etc. came out negative. As I became sicker it was decided that I needed an emergency colonoscopy. During the colonoscopy they extracted stool and it was this sample that came back positive for the fist time. I was even on Flagyl (500mg 3x/day)at the time which they had put me on prior as a "just in case". I never knew if I had Pseudomembranes as all of my tests except the last one were done while I was either on Flagyl or Vanco. I am 99.9% that if they were done while I was not on the meds, they would have found them as I usually had severe bleeding with my relapses. Make sure you are off of meds. about 14 days prior for the most accurate results.