Diagnostic testing methods for Clostridium difficile infection: A statewide survey of Ohio acute care hospitals

ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

“…[386] Some authors now recommend use of a single-step, highly sensitive NAAT instead of EIAs that test for toxins or multistep testing for C. difficile bacterial products or genes. [384,387] However, the limited PPV and high cost limit the use of NAAT as a stand-alone test. Therefore, since no single test is suitable as a stand-alone test, some European guidelines recommended a two-step algorithm to optimize CDI diagnosis.…”

Clostridioides difficile infections in Saudi Arabia: Where are we standing?

“…The main downside of this single step technique is that it may detects gene encoding the toxin rather than the actual toxins which may lead to the over-diagnosis of CDIs, knowing that up to 21% of hospitalized patients are asymptomatically colonized with C. difficile ( Guh et al, 2020 , Truong et al, 2017 ). On the other hand, the two-step algorithm for the detection of CDIs utilize EIAs for toxins detection and then confirming the positive cases with the NAAT ( Cohen et al, 2010 , Wong et al, 2017 ). Hence, Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommended a multi-step protocol using glutamate dehydrogenase (GDH) antigen/toxin A/B combined with NAAT as the most accurate method for CDIs diagnosis ( McDonald et al, 2018 ).…”

Laboratory Diagnosis of Clostridium difficile Infection in Korea: The First National Survey

“…Toxin AB EIA is more frequently used possibly because of its advantages of short turnaround time and cost-efficiency. However, this assay is often criticized for its poor sensitivity and should therefore no longer be considered as a stand-alone assay for the diagnosis of CDI [12679101112]. Therefore, the nine (15.8%) laboratories that use only the toxin AB EIA for CDI diagnosis should reconsider their diagnostic strategy.…”

“…Since the clinical guidelines for CDI provided by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) were updated in 2010 [13], many hospitals in the United States have switched the toxin AB EIA to NAATs for CDI diagnosis. Wong et al [10] reported that 84.5% of the hospitals surveyed in Ohio, USA, used NAATs as a stand-alone assay in 2014. However, the proportion of laboratories using NAATs as a stand-alone assay was lower in other countries: only 3% and 6% of small (<500 beds) and large (>500 beds) hospitals in Italy in 2012–2013, respectively [11], 0.9% of participating laboratories in Spain in 2013 [12], and 11.1% (2/18) of hospitals in Israel in 2012 [14].…”