Tests for Clostridium difficile Infection

Clostridium difficile is a Gram-positive, spore forming, anaerobic bacillus in the intestinal flora. The most frequent cause of nosocomial and antibiotic-related diarrheal illnesses. The prevalence of Clostridium difficile infections and their increasing morbidity, which are linked to extended inpatient stays and a sharp rise in the usage of hygiene management, result in a marked rise in hospital treatment expenses.  

Currently, laboratory tests to diagnose Clostridium difficile infection include toxigenic culture, glutamate dehydrogenase (GDH), nucleic acid amplification test (NAAT) and toxins A/B enzyme immunoassay (EIA). To distinguish between colonization and clinical infection, it is essential to develop strategies to improve the clinical sensitivity and specificity of existing laboratory assays.  A multistep approach to diagnosis, such as either GDH or NAAT followed by toxins A/B EIA in conjunction with laboratory stewardship by evaluating Clostridium difficile test orders for appropriateness and providing feedback, is advised to achieve high diagnostic yield.

To achieve the dual goals of reducing infection rates and antibiotic resistance strains, it is essential to identify the clinical infection and separate it from asymptomatic carriage or colonization. In order to decrease the incidence of infections brought on by the use of broad spectrum antibiotics and to lower the risk of mistreating Clostridium difficile colonization, diagnostic and antimicrobial stewardship must be combined with provider education on appropriate Clostridium difficile testing.

It is crucial but difficult to select the best diagnostic test depending on the actual disease rates in the community at hand. Let's examine the numerous tests that can be used to diagnose Clostridium difficile infection.