Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical...Continue Reading
Laboratory diagnosis of Clostridium difficile-associated gastrointestinal disease: comparison of a monoclonal antibody enzyme immunoassay for toxins A and B with a monoclonal antibody enzyme immunoassay for toxin A only and two cytotoxicity assays.
Use of the polymerase chain reaction for the specific and direct detection of Clostridium difficile in human feces
Numerical index of the discriminatory ability of typing systems: an application of Simpson's index of diversity.
Comparison of alcohol shock enrichment and selective enrichment for the isolation of Clostridium difficile
Interaction of Clostridium difficile and Escherichia coli with microfloras in continuous-flow cultures and gnotobiotic mice.
The intestinal microflora of infants: composition of fecal flora in breast-fed and bottle-fed infants
Suppression of Clostridium difficile by normal hamster cecal flora and prevention of antibiotic-associated cecitis.
Comparison of restriction endonuclease analysis, ribotyping, and pulsed-field gel electrophoresis for molecular differentiation of Clostridium difficile strains.
Role of culture and toxin detection in laboratory testing for diagnosis of Clostridium difficile-associated diarrhea
Comparison of cycloserine-cefoxitin-fructose agar (CCFA) and taurocholate-CCFA for recovery of Clostridium difficile during surveillance of hospitalized patients
Fecal lactoferrin, interleukin-1beta, and interleukin-8 are elevated in patients with severe Clostridium difficile colitis.
Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms
PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes
Susceptibility testing of Clostridium difficile against metronidazole and vancomycin by disk diffusion and Etest
Development of a new PCR-ribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing
Value of lysozyme agar incorporation and alkaline thioglycollate exposure for the environmental recovery of Clostridium difficile
High prevalence of diarrhea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients
Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality
Comparison of the E test to the reference agar dilution method for antibiotic susceptibility testing of Clostridium difficile
Determining confidence intervals when measuring genetic diversity and the discriminatory abilities of typing methods for microorganisms
Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications
Clinical usefulness of components of the Triage immunoassay, enzyme immunoassay for toxins A and B, and cytotoxin B tissue culture assay for the diagnosis of Clostridium difficile diarrhea
The fatal enteric cholera infection in the guinea pig, achieved by inhibition of normal enteric flora
Multilocus sequence typing analysis of human and animal Clostridium difficile isolates of various toxigenic types
Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens
Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity
Clostridium difficile and inflammatory bowel disease: role in pathogenesis and implications in treatment
Ribotype 027 Clostridium difficile infections with measurable stool toxin have increased lactoferrin and are associated with a higher mortality
Evaluation of the illumigene C. difficile assay for toxigenic Clostridium difficile detection: a prospective study of 302 consecutive clinical fecal samples
Comparison of Simplexa universal direct PCR with cytotoxicity assay for diagnosis of Clostridium difficile infection: performance, cost, and correlation with disease
Trends and changes in Clostridium difficile diagnostic policies and their impact on the proportion of positive samples: a national survey
Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples?
Evaluation of 3 automated real-time PCR (Xpert C. difficile assay, BD MAX Cdiff, and IMDx C. difficile for Abbott m2000 assay) for detecting Clostridium difficile toxin gene compared to toxigenic culture in stool specimens
Comparison of the Verigene Clostridium difficile, Simplexa C. difficile Universal Direct, BD MAX Cdiff, and Xpert C. difficile assays for the detection of toxigenic C. difficile
Clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care
Impact of a Healthcare Provider Educational Intervention on Frequency of Clostridium difficile Polymerase Chain Reaction Testing in Children: A Segmented Regression Analysis
Low frequency of asymptomatic carriage of toxigenic Clostridium difficile in an acute care geriatric hospital: prospective cohort study in Switzerland
Comparison of the Vidas C. difficile and Quik Chek-60 glutamate dehydrogenase assays for the detection of Clostridium difficile in faecal samples
Comparison of enzyme immunoassays and rapid diagnostic tests for clostridium difficile glutamate dehydrogenase and toxin a + B to toxinogenic culture on a highly selective chromogenic medium
European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection
Multiplexed Molecular Diagnostics for Respiratory, Gastrointestinal, and Central Nervous System Infections
Clostridium difficile infection epidemiology and management: Comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in Northern Italy
Clinical use comparison of a semiautomated PCR with fluorescent ribotyping for typing of Clostridium difficile
Evaluation of the novel artus C. difficile QS-RGQ, VanR QS-RGQ and MRSA/SA QS-RGQ assays for the laboratory diagnosis of Clostridium difficile infection (CDI), and for vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) screening
Nonculture molecular techniques for diagnosis of bacterial disease in animals: a diagnostic laboratory perspective
Evaluation of the performance of C. DIFF QUIK CHEK COMPLETE and its usefulness in a hospital setting with a high prevalence of Clostridium difficile infection
The new frontier of diagnostics: Molecular assays and their role in infection prevention and control
Diagnosis and outcome of Clostridium difficile infection by toxin enzyme immunoassay and polymerase chain reaction in an island population
Comparative performance study of six commercial molecular assays for rapid detection of toxigenic Clostridium difficile
Biomimetic Bacterial Identification Platform Based on Thermal Wave Transport Analysis (TWTA) through Surface-Imprinted Polymers
Clostridium difficile and cystic fibrosis: management strategies and the role of faecal transplantation
NASPGHAN Clinical Report: Surveillance, Diagnosis, and Prevention of Infectious Diseases in Pediatric Patients With Inflammatory Bowel Disease Receiving Tumor Necrosis Factor-α Inhibitors
Rapid detection of Clostridium difficile toxins and laboratory diagnosis of Clostridium difficile infections
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