INFECTION CONTROL
to perform molecular typing and susceptibility testing on recovered isolates from positive samples and can be used for outbreak investigations and samples with a positive GDH EIA and/or NAAT but a negative toxin A/B EIA may either be samples that tested falsely positive on GDH EIA/NAAT or samples containing C. difficile, but without detectable free toxin. To be able to discern between these two conditions, a third-stage reflex test to either a TC or NAAT or GDH can be performed on samples with discordant results. For patients with evidence of C. difficile but negative toxin A/B EIA, clinical evaluation is needed, and clinical considerations come into play to determine a case as either positive or negative; these patients can either be CDI patients with undetectable toxin levels, or false-negative toxin A/B EIA results or potential carriers of toxigenic C. difficile. The decision to treat CDI will, ultimately, be a clinical one, guided by laboratory results. No tests are infallible, so it may be clinically justified to treat a patient for CDI despite negative test results and treatment should not be withheld on the basis of
laboratory tests alone, say the guidelines. However, patients with toxin-negative specimens should have alternative diagnoses considered and excluded. Provided that an adequate testing strategy is followed, most patients with negative results for CDI will
Despite the development of new tests for CDI, the routine use of any single test for diagnosis is not recommended, irrespective on the technology on which it is based.
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truly not have this infection, and so treatment will be unnecessary.
References
1 M.J.T. Crobach, T. Planche, C. Eckert, F. Barbut, E.M. Terveer, O.M. Dekkers, M.H. Wilcox, E.J. Kuijper. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): update of the diagnostic guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect 2016.
2 Barbut, F., Surgers, L., Eckert, C., Visseaux, B., Cuingnet, M., Mesquita, C. et al, Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management? Clin Microbiol Infect. 2014;20:136–144.
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