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. 2016 Jan;24(1):3-10.
doi: 10.1097/IPC.0000000000000350.

Diagnosis and Treatment of Clostridium difficile Infection (CDI)

Dale N Gerding  1   2 , Thomas M File Jr  3   4 , L Clifford McDonald  5
Affiliations

Diagnosis and Treatment of Clostridium difficile Infection (CDI)

Dale N Gerding et al. Infect Dis Clin Pract (Baltim Md). 2016 Jan.

Abstract

Early and accurate diagnosis is essential for optimal treatment of individuals with Clostridium difficile infection (CDI) and for implementation of effective infection control procedures. The decision about which diagnostic test to use is an important one that should be based on test sensitivity, specificity, and predictive value. The challenges of CDI go beyond rapid identification and management of symptomatic patients. Asymptomatic carriage has long been suspected in C. difficile transmission, but it may play a larger role than previously thought. Emerging information also shows that patients treated for CDI remain colonized for many weeks after symptom resolution. In fact, stool culture positivity increases during the first weeks following treatment completion. Treatments that reduce the duration and degree of asymptomatic shedding could have added benefit for reduced transmission.

Keywords: CDI; Clostridium difficile; diagnostic test; treatment.

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Conflict of interest statement

Disclosures: NFID must ensure balance, independence, objectivity, and scientific rigor in its educational activities. All individuals with control over content are required to disclose any relevant financial interest or other relationship with manufacturer(s) of any product or service discussed in an educational presentation and/or with the commercial supporters of this activity. Disclosure information is reviewed in advance to manage and resolve any conflict of interest, real or apparent, that may affect the balance and scientific integrity of an educational activity. Marla Dalton, CAE (NFID staff, content reviewer) owns stock, stock options, or bonds from Merck & Co. Inc. Thomas M. File, Jr. MD (author) served as an advisor or consultant for Astellas, Cubist, Durata, GlaxoSmithKline, Nabriva, Pfizer Inc., and Tetraphase and received grant or research support from Cempra and Pfizer Inc. Dale N. Gerding, MD (author) holds patents for the treatment and prevention of C. difficile infection licensed to ViroPharma/Shire, and is a consultant or advisory board member for Merck & Co. Inc, Cubist, Actelion Pharmaceuticals Ltd, Sanofi Pasteur, Rebiotix Inc., Da Volterra, Pfizer Inc., Summit Pharmaceuticals International, and ViroPharma/Shire.William Schaffner, MD (NFID Medical Director, content reviewer) served as an advisor or consultant for Merck & Co., Inc., Pfizer Inc., and Novavax. All other planners and content reviewers have no funding or conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Predictive Value for a Theoretical Test Based on True CDI Disease Prevalence [Planche Lancet Infect Dis 2008]
Effect of varying prevalence on the PPV and NPV of a theoretical Clostridium difficile toxin assay with a sensitivity of 92% and a specificity of 97% NPV=negative predictive value. PPV=positive predictive value.
See this image and copyright information in PMC

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