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Clostridium difficile causes 15-25% of all antibiotic-associated diarrhea (AAD) and >90% of antibiotic-associated pseudomembranous colitis (PMC).
Tests generally appear in the order most useful for common clinical situations
| Test name: CBC with Platelet Count & Automated Differential |
| ARUP #: 0040003 |
| Methodology: Automated Cell Count with Flow Cell Differential |
| Use: Aid in determining cause of diarrhea; leukocytosis suggests bacterial etiology |
| Test name: Stool Culture, Routine (Includes E. coli Shiga-like Toxin by EIA 0060047) |
| ARUP #: 0060134 |
| Methodology: Standard reference procedures for Salmonella, Shigella, Campylobacter, and E. coli 0157 culture and identification. |
| Use: Rule out other organisms as cause of diarrhea Routine stool culture includes culture for Salmonella, Shigella, Campylobacter, and E. coli 0157 as well as EIA for Shiga-like toxin from E. coli |
| Test name: Clostridium difficile toxin B gene (tcdB) by PCR |
| ARUP #: 2002838 |
| Methodology: Qualitative Polymerase Chain Reaction |
| Use: Use for rapid and clinically relevant diagnosis; test is highly sensitive Follow-up test for positive results for GDH or other testing for toxin-producing strain |
| Test name: Clostridium difficile Cytotoxin Cell Assay |
| ARUP #: 0060851 |
| Methodology: Cell Culture Assay/Confirmation by Anti-Toxin Neutralization |
| Use: Use for clinically relevant diagnosis; test is the most specific and is highly sensitive |
| Limitations: May take up to 48 hours to get results |
| Test name: Clostridium difficile Toxins (A & B) by EIA |
| ARUP #: 0065146 |
| Methodology: Qualitative Enzyme Immunoassay |
| Use: Use for rapid and clinically relevant diagnosis; test is less sensitive (70-90%) than culture or cell assay Follow-up test for positive results for GDH or other testing for toxin-producing strain Not preferred initial test; use toxin B gene test instead Do not use as stand-alone diagnostic test |
| Limitations: False-negative results are common |
| Test name: Clostridium difficile Culture with Reflex to Cytotoxin Cell Assay |
| ARUP #: 0060140 |
| Methodology: Standard reference procedures for anaerobic bacterial culture and identification |
| Use: Gold standard for C. difficile testing If C. difficile culture is positive, then C. difficile cytotoxin cell assay is added For routine stool screening, refer to Clostridium difficile toxin B gene (tcdB) by PCR |
| Limitations: Culture alone does not distinguish toxin-producing strains Requires up to 72 hours for report |
| Test name: Clostridium difficile Cytotoxin Antibody by Neutralization |
| ARUP #: 2002552 |
| Methodology: Antibody Neutralization |
| Use: Research use only; not for initial diagnosis of C. difficile-associated diarrhea |