Clostridium difficile

Clostridium difficile produces disease-causing toxins A and B and is the most common cause of healthcare-associated infection in adults in the United States and the most frequent cause of infectious diarrhea in clinical settings.   C. difficile infection (CDI) is defined as acute-onset diarrhea in the presence of toxigenic C. difficile or C. difficile toxins, with no other known cause for diarrhea.  Beginning in 2000, CDI increased in severity and incidence in both children and adults with the emergence of a more virulent strain known as ribotype 027 (also called NAP1 or BI).  The current estimated rate of CDI is approximately 500,000 cases per year, and transmission is typically person to person, through the fecal-oral route.   CDI severity has been defined in various ways on the basis of clinical findings, laboratory data, intensive care unit (ICU) stay, colectomy, and/or mortality.  The high prevalence of asymptomatic colonization, found in up to 5-50% of inpatients, complicates diagnosis, and controversy exists about whether diagnostic testing should focus on testing stool for toxins or for toxigenic C. difficile organisms.  Currently recommended tests include the nucleic acid amplification test (NAAT) as well as a stool toxin enzyme immunoassay (EIA) and glutamate dehydrogenase (GDH) test. 

Tabs Content
Content Review: 
October 2018

Last Update: May 2019