Clostridium difficile Diagnostics in Long-Term Care Facilities

Abstract

Clostridium difficile (C. difficile) infection (CDI) is an increasing common healthcare-associated infection and disproportionally affects our elderly patients and patients in long-term care facilities (LTCFs) (Asempa and Nicolau, Clin Interv Aging. 12:1799, 2017). As described in other chapters of this book, patients with CDI can have multiple loose or watery stools in 1 day causing extreme dehydration, electrolyte disarray, sepsis, toxic megacolon, and even death. With the increasing prevalence and severity of CDI over the past decade, clinicians are understandably concerned when suspecting CDI in one of their patients and keen to test to see if C. difficile is present in the stool. However, the presence of C. difficile in the stool is not sufficient to diagnose CDI, and the current diagnostic tests commercially available are complex. CDI is a toxin-mediated infection and therefore, diagnostic assays often focus on the presence of toxin as a necessary component to develop infection, as opposed to colonization with non-toxigenic C. difficile strain. Nucleic acid amplification test (NAAT), enzyme immunoassay (EIA), and cytotoxigenic culture (CC) and cell cytotoxicity assay (CCTA) are available options. A multistep algorithmic approach has been recommended to utilize the above-mentioned testing. Diagnostics are challenged by decreased immune response in the elderly and delays in an LTCF setting. In this chapter, we will describe the different C. difficile diagnostic tests and their appropriate use in clinical practice in long-term care patients.