Current knowledge on the laboratory diagnosis ofClostridium difficileinfection

Abstract

Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from self-limited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Due to extensive antibiotic usage, the number of CDIs has increased. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with the disease, mainly with regards to antibiotic management. The diagnosis of CDI is primarily based on the clinical signs and symptoms and is only confirmed by laboratory testing. Despite the high burden of CDI and the increasing interest in the disease, episodes of CDI are often misdiagnosed. The reasons for misdiagnosis are the lack of clinical suspicion or the use of inappropriate tests. The proper diagnosis of CDI reduces transmission, prevents inadequate or unnecessary treatments, and assures best antibiotic treatment. We review the options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention of CDI.

Advances in the diagnosis and treatment of Clostridium difficile infections

“…In particular, some NAATs such as multiplex NAATs can simultaneously detect C. difficile strains and toxin encoding genes from stool samples 29 . There are several commercially available NAATs, including a real-time PCR (RT-PCR) assay and loop-mediated isothermal amplification (LAMP) assay, both of which have an overall high analytical sensitivity (80–100%) and specificity (87–99%) 30 . In addition, several multiplex NAATs panels/platforms have been developed to detect stool pathogens including C. difficile from stool specimens.…”

Clostridioides (Clostridium) difficile carriage in asymptomatic children since 2010: a narrative review

“…It is alarming that since 2000, there has been emergence and subsequent increase in infections caused by hypervirulent strains such as PCR ribotypes 027 and 078 [10,24]. In asymptomatic children, however, carriage of hypervirulent C. difficile has been usually low (0.1%) or absent according to studies from China, France, Japan and the United Kingdom [25][26][27][28][29][30][31].…”

“…Only toxigenic C. difficile strains cause disease after expression of two toxins: enterotoxin (toxin A) and cytotoxin (toxin B) encoded by tcdA and tcdB genes, respectively [9]. Since 2000, there has been broad spreading of hypervirulent strains such as PCR ribotypes 027 and 078, which can produce more toxins than classical strains, can have an additional third binary toxin and deletions in some genes, increasing toxin production, and fluoroquinolone resistance [10].…”

Colonization of Toxigenic Clostridium difficile Among Intensive Care Unit Patients: A Multi-Centre Cross-Sectional Study

“…Routine detection methods of CD includes toxigenic culture, cell cytotoxic neutralization assay, glutamate dehydrogenase assay, enzyme immunoassays, nucleic acid amplification tests, etc. (Martinez-Melendez et al, 2017). However, the popularization of these methods may be problematic in developing countries, likely due to limitations in awareness, laboratory capacity and capabilities, and surveillance systems (Collins et al, 2013;Forrester et al, 2017).…”