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Management of Clostridium difficile Infection: Survey of Practices and Compliance with National Guidelines Among Primary Care Physicians

the obtaining of urine samples did not increase our ability to identify colonized subjects. Moreover, the significance of the rare finding of unique strains of E. coli identified in some of the urine samples is unclear, because none of the subjects showed any evidence of clinical infection; colonization with these strains appeared to be transient, and they were not detected again in subsequent stool samples. Although the use of urine samples may provide a greater measure of the total exposure of patients to colonizing strains of E. coli, our data suggest that unique strains detected solely in urinary samples may be transient colonizers, because none of these strains were detected in any subsequent perirectal swab samples. Whether the added effort of collecting urine samples is warranted will depend primarily on the goals of the initiative or study.