What are the recommendations for toxin testing in stool in individuals with suspected Clostridium difficile (C diff) infection (CDI)?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Answer

Toxin testing has the most important clinical relevance, but its lack of sensitivity is an issue. The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) suggest an interim strategy; ie, a 2-step method that has the potential to overcome the sensitivity concern. [5] It would be carried out as follows:

  • For the initial screening, use EIA detection of GDH

  • This would be followed by a confirmatory test only for GDH-positive stool specimens by cell cytotoxic assay or toxigenic culture

In addition, the SHEA and IDSA note that although PCR assay testing appears to be rapid, sensitive, and specific, further research is needed before it can be recommended for routine testing in cases of suspected CDI. [5]


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