Ann Clin Microbiol 2024;27:3-10. Laboratory diagnosis of Clostridioides difficile infection: guidelines and status of practice in Korea
| References | [12] | [15] | [16] |
|---|---|---|---|
| Organizations | European Society of Clinical Microbiology and Infectious Diseases (ESCMID) | Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA) | >American College of G astroenterology (ACG) |
| Diagnosis of CDI | Clinical signs and symptoms in combination with laboratory tests | The presence of symptoms and either a laboratory test positive, or colonoscopic or histopathologic findings revealing pseudomembranous colitis | No single test can replace clinical acumen Diagnosis and decision to treat are clinical issues |
| Indications for CDI testing | Age ≥ 3 years Unformed stool samples Formed stool samples should not be tested (except in the case of paralytic ileus) In patients suspected of ileus, a rectal swab can be used. | Patients with unexplained and newonset, with three or more unformed stools in 24 hours Refuse a specimen from a patient receiving laxatives. | Individuals with symptoms suggestive of active CDI (three or more unformed stools in 24 hours) Exception: formed stool may be tested for infection control purposes, documentation of colonization, etc. Rectal swabs for PCR may be useful for patients with an ileus |
| Recommendations for stand-alone testing | Not recommended | NAAT alone can be tested if there are pre-agreed institutional criteria for patient stool submission | No single test is suitable to be used as a stand-alone test |
| Recommendations for multistep algorithm | 2-step algorithm NAAT or GDH → Toxin AB → TC or NAAT (Optional) GDH and Toxin AB → TC or NAAT (Optional) | Stool toxin test as part of multistep algorithm GDH plus toxin GDH plus toxin, arbitrated by NAAT NAAT plus toxin | Algorithms should include both a highly sensitive and a highly specific testing modality 2-step algorithm GDH or NAAT → Toxin A/B |