Epidemiology, Diagnosis and Treatment of Clostridium Difficile Infection

Matteo Bassetti; Giovanni Villa; Davide Pecori; Alessandra Arzese; Mark Wilcox


Expert Rev Anti Infect Ther. 2012;10(12):1405-1423. 

In This Article


All of the types of in vitro assays for CDI that are currently available are diagnostic aids that microbiologists can offer to the physicians; it is important that laboratory results are related to the patient history. Since the diagnosis of CDI is usually based on clinical history and diarrhea, in combination with laboratory tests, rapid and accurate microbiological diagnosis is important. For this purpose, diagnostic algorithms that can provide high sensitivity, rapid turnaround time, and ease of performance have been elaborated by several authors in recent times.[82–84,204] Although rapid results and high sensitivity are the hallmarks of an ideal screening test, unless a patient has toxic megacolon or PMC, diagnostic testing for CDI could be argued not to require immediate turnaround times.[85] Preemptive antibiotic therapy is often started by clinicians based on CDI clinical evidence, prior to the availability of diagnostic test results. However, the value of a CDI rapid diagnostic algorithm is enforced by the possibility of reducing unnecessary antibiotic treatment and implementation of infection control precautions. The latter point has become increasingly important with the recognition that reduction of transmission of virulent strains is a key way to control CDI in hospital settings.

A major distinction should be made between protocols applied to C. difficile for epidemiological studies and outbreak investigation and those designed for the needs of routine testing for diagnostics. In the latter case, laboratory tests and algorithm should be optimised for CDI diagnosis. As CDI pathogenesis is due to C. difficile in vivo toxin(s) production, diagnostic laboratory protocols should consider toxin(s) detection assays.