Document Type
Article
Publication Date
11-2011
Publication Source
The Journal of Molecular Diagnostics
Abstract
The laboratory diagnosis of Clostridium difficile infection (CDI) continues to be challenging. Recent guidelines from professional societies in the United States note that enzyme immunoassays for toxins A and B do not have adequate sensitivity to be used alone for detecting CDI, yet the optimal method for diagnosing this infection remains unclear. Nucleic acid amplification tests (NAATs) that target chromosomal toxin genes (usually the toxin B gene, tcdB) show high sensitivity and specificity, provide rapid results, and are amenable to both batch and on-demand testing, but these tests were not universally recommended for routine use in the recent guidelines. Rather, two-step algorithms that use glutamate dehydrogenase (GDH) assays to screen for C. difficile in stool specimens, followed by either direct cytotoxin testing or culture to identify toxin-producing C. difficile isolates, were recommended in one guideline and either GDH algorithms or NAATs were recommended in another guideline. Unfortunately, neither culture nor direct cytotoxin testing is widely available. In addition, this two-step approach requires 48 to 92 hours to complete, which may delay the initiation of therapy and critical infection control measures. Recent studies also show the sensitivity of several GDH assays to be <90%. This review considers the role of NAATs for diagnosing CDI and explores their potential advantages over two-step algorithms, including shorter time to results, while providing comparable, if not superior, accuracy.
Inclusive pages
573-582
ISBN/ISSN
Print: 1525-1578
Document Version
Postprint
Publisher
Elsevier
Volume
13
Peer Reviewed
yes
Issue
6
eCommons Citation
Tenover, Fred C.; Baron, Ellen Jo; Peterson, Lance R.; and Persing, David, "Laboratory Diagnosis of Clostridium difficile Infection: Can Molecular Amplification Methods Move Us Out of Uncertainty?" (2011). Biology Faculty Publications. 338.
https://ecommons.udayton.edu/bio_fac_pub/338
COinS
Comments
The document available for download is the authors' accepted manuscript from PubMed Central. To view the version of record, use the DOI: https://doi.org/10.1016/j.jmoldx.2011.06.001
PMC ID: PMC3194048
Articles from The Journal of Molecular Diagnostics are provided to PubMed Central courtesy of the American Society for Investigative Pathology.