In a home enteral nutrition patient with new onset diarrhea after pneumonia, what is the first recommended intervention?

• A. Obtain a Clostridium difficile toxin stool assay
• B. Change to elemental feeding
• C. Bile-sequestering agent
• D. Obtain an order for an antidiarrheal medication

Answer: (A)

Antibiotic exposure from treating pneumonia can lead to Clostridioides difficile infection, a common cause of new diarrhea in enteral nutrition patients. The best first step is to obtain a stool assay for C. difficile toxin to confirm infection before making changes to the feeding plan or starting antidiarrheal therapy. A positive result directs appropriate treatment and infection control, while a negative result prompts evaluation for other causes such as formula intolerance, medications, or other infections. Rushing to change the formula or use antidiarrheals can mask or worsen an infectious process, and a bile-sequestering agent would not address the likely infectious etiology.