COMMENTARY

5 Important Developments in C difficile Management

John G. Bartlett, MD

Disclosures

August 26, 2013

In This Article

Does the Nose Know?

It has long been claimed that nurses can identify patients with CDI by the odor in an infected patient's room or the odor of the stool, although this has not been verified in clinical trials.[7] Because dogs have an olfactory sense that is approximately 300 times that of humans, investigators in The Netherlands[8] trained a beagle to detect the odor of p-cresol (a phenolic compound that results from the fermentation of tyrosine), which is thought to be the source of the odor of C difficile. The dog was taught to sit if the specimen was positive.

The beagle's performance in a trial was near perfect. Compared with results of clinical and laboratory studies for C difficile, the dog recognized positive cases in 30 of 30 instances of CDI and identified negative tests in 270 of 270 specimens from patients without CDI. In fact, the dog was even able to recognize a case by exposure to the patient's ward in 25 of 30 cases (83%) and correctly eliminated CDI by the ward walk-through in 265 of 270 negative cases.

Clinical relevance. Although the original investigators suggest that dogs could be used in hospitals to "sniff out" CDI if precautions are taken to protect patients, it is unlikely that this method will be widely adopted.

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