Laboratory Diagnosis of Clostridium difficile Infections: There Is Light at the End of the Colon

• Published in: Clinical infectious diseases Vol. 57; no. 8; pp. 1175 - 1181
• Main Authors: Brecher, Stephen M., Novak-Weekley, Susan M., Nagy, Elisabeth
• Format: Journal Article
• Language: English
• Published: Oxford OXFORD UNIVERSITY PRESS 15.10.2013; Oxford University Press
• Subjects: Algorithms; Antibiotics; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacteriological Techniques - methods; Bacteriological Techniques - standards; Biological and medical sciences; CLINICAL PRACTICE; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium Infections - diagnosis; Clostridium Infections - microbiology; Diarrhea; Gastroenterology. Liver. Pancreas. Abdomen; Gram-positive bacteria; Human bacterial diseases; Humans; Immunoassay; Immunoenzyme techniques; Infections; Infectious diseases; Medical diagnosis; Medical practice; Medical sciences; Microbiology; Other diseases. Semiology; Polymerase chain reaction; Practice Guidelines as Topic; Specimens; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Toxins; Infection; Clostridiaceae; Clostridium difficile; Clostridiales; Diarrhea; Bacteria; Digestive diseases; Intestinal disease; Colon; Diagnosis; Laboratory; laboratory design of C. difficile; Brecher guidelines
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cit424

Single molecular or multistep assays (glutamate dehydrogenase, toxin A/B, ± molecular) are recommended for the diagnosis of CDI in patients with clinically significant diarrhea. Rapid and accurate tests can improve resource allocations and improve patient care. Enzyme immunoassay (EIA) for toxins A/B is too insensitive for use as a stand-alone assay. This guideline will examine the use of molecular tests and multitest algorithms for the diagnosis of Clostridium difficile infection (CDI). These new tests, alone or in a multistep algorithm consisting of >1 assay, are more expensive than the older EIA assays; however, rapid and accurate testing can save money overall by initiating appropriate treatment and infection control protocols sooner and by possibly reducing length of hospital stay. We recommend testing only unformed stool in patients with clinically significant diarrhea by a molecular method or by a 2- to 3-step algorithm.