Laboratory testing for C difficile remains controversial because many different types of diagnostic tests are available, with detection of different targets and different performance characteristics. Factors that enter into the choice of test include rapid turnaround, specificity, sensitivity, and cost.
On the basis of correlation with mortality, the best reference method for the diagnosis of Clostridium difficile infection (CDI) is the cytotoxin assay and a multistep algorithm combining a highly sensitive first test (such as glutamate dehydrogenase or nucleic acid amplification) followed by a more specific test (such as enzyme immunoassay) to confirm positive results. This appears to be the optimal diagnostic testing strategy.
From an infection control standpoint, the field of CDI prevention is evolving rapidly, and accurate and timely diagnosis of CDI will be important in assessing the efficacy of prevention strategies.
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