What is the best test to evaluate for Clostridium difficile infection?
- Traditionally, the diagnosis of C. difficile infection was based on EIA tests and confirmatory toxigenic cultures or cytotoxic assays.
- The limited sensitivity of EIA tests, along with the time and labor requirements of the confirmatory tests, prompted the development of more rapid and reliable tests.
- PCR tests have become the test of choice in many institutions, as they are rapid (within hours) and highly sensitive and specific.
- Loop-mediated isothermal amplification assays are even faster (1 hour) and simpler than PCR and may play a larger role in diagnosing C. difficile in the future .
- Infection Diseases Society of American guidelines from 2010 still recommend a two-step procedure with an initial EIA test for glutamate dehydrogenase (GDH) followed by a confirmatory toxigenic culture assay or cell culture cytotoxin B assay.
- Endoscopy is an insensitive, invasive, and expensive means of diagnosis and should not be routinely employed for this purpose.
