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Recommendations for C. Difficile Testing in Clinical Settings

This guide outlines best practices for testing for Clostridioides difficile infection (CDI) as recommended by Dr. Alfred DeMaria Jr., State Epidemiologist. It discusses the limitations and proper use of various testing methods, highlighting that culture and toxin neutralization are impractical in most labs but serve as the gold standard. While the enzyme immunoassay (EIA) for toxins A and/or B is easy to perform, it has low sensitivity and risks false negatives. The more accurate PCR test is suggested to identify toxigenic strains. Key rules include testing only unformed stools, avoiding repeat testing, and not testing for cure.

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Recommendations for C. Difficile Testing in Clinical Settings

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  1. C. Difficile Testing Recommendations Alfred DeMaria, Jr., M.D. Medical Director Bureau of Infectious Disease    Prevention, Response and Services State Epidemiologist

  2. Testing for C. difficile • Testing for CDI: • Culture and toxin neutralization not practical in most laboratories (but gold standard) • EIA for toxins A and/or B is easy to do, but not very sensitive (giving false negatives) • GDH tells you C. difficile is present, but doesn’t tell you if it is toxin-producing • GDH+ plus EIA+ = toxigenic C. difficile, but still have sensitivity problem related to EIA • PCR more sensitive and as specific, and it identifies A&B toxin gene

  3. C. Difficile Test “Rules” • Only test unformed diarrheal stools • Do not do repeat testing • Do not test for “cure”

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