Optimizing the diagnostic testing of Clostridium difficile infection

ABSTRACT

Introduction: Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhea and is associated with a considerable health and cost burden. However, there is still not a clear consensus on the best laboratory diagnosis approach and a wide variation of testing methods and strategies can be encountered.

Areas covered: We aim to review the most practical aspects of CDI diagnosis providing our own view on how to optimize CDI diagnosis.

Expert commentary: Laboratory diagnosis in search of C. difficile toxins should be applied to all fecal diarrheic samples reaching the microbiology laboratory in patients > 2 years old, with or without classic risk factors for CDI. Detection of toxins either directly in the fecal sample or in the bacteria isolated in culture confirm CDI in the proper clinical setting. Nuclear Acid Assay techniques (NAAT) allow to speed up the process with epidemiological and therapeutic consequences.

KEYWORDS:

• Clostridium difficile
• laboratory diagnosis
• diagnostic algorithms
• nucleic acid amplification tests
• toxigenic culture
• cell cytotoxicity assay
• enzyme immune assay

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was funded by the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain, Fondo de Investigaciones Sanitarias (FIS), Research Project number PI13/00687 of the Carlos III Health Institute (ISCIII) and by the European Regional Development Fund (FEDER) ‘A way of making Europe’.