How is Clostridium difficile infection diagnosed

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.

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