The updated clinical practice guidelines for Clostridium difficile infection, or CDI, in adults and children were recently issued by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The new guidelines were prompted by extensive research published since the release of the 2010 guidelines that has enhanced our understanding of CDI management.
The new guidelines address differentiating C. difficile colonization or carriage from active CDI. Concerns of overtreatment of CDI led to the new recommendation that individuals who do not meet the criterion of diarrhea (> 3 unformed stools within a 24-hour period) not be tested. The guidelines also recommend the adoption of multistep algorithms to enhance sensitivity of C. difficile testing when appropriately submitted stool specimens cannot be guaranteed. In cases in which an in-house algorithm for screening acceptable specimens cannot be implemented, the guidelines recommend a testing and validation approach with:
- glutamate dehydrogenase (GDH) antigen testing, followed by toxin testing in specimens testing positive;
- GDH, followed by toxin testing of positive specimens, arbitrated by NAAT in the case of discordance; or
- NAAT-positive specimens verified by toxin testing.
European guidelines recommend similar approaches. The unique C. DIFF QUIK CHEK COMPLETE® test from Alere (developed and manufactured by TechLab® Inc.) detects GDH and Toxin A/B simultaneously in less than 30 minutes providing a unique solution to meet the recommendations of the new guidelines.
You can read the full details of the new guidelines at: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/cix1085/4855916