Stools samples from hospitalized inpatients and ambulatory outpatients presenting to the main hospital or UMHS off-site facilities were obtained, stored in Cary-Blair transport media and tested for C. difficile as described.20 (link) Specifically, clinician-ordered stool specimens were tested for the presence of C. difficile glutamate dehydrogenase antigen and toxins A and B using the C. DIFFICILE QUIK CHEK COMPLETE®test (Techlab, Inc., Blacksburg, VA, USA). All antigen/toxin discordant stool tests were subjected to analysis for the tcdB gene by real-time polymerase chain reaction (PCR) (BD GeneOhm™ Cdiff Assay; Franklin Lakes, NJ, USA). C. difficile presence was confirmed by growth on taurocholate-cycloserine cefoxitin fructose agar plates and brain heart infusion-supplemented tubes at 37°C as described.21 (link) Remaining stool samples were aliquoted and stored at −80°C.