title: Optimizing the diagnostic testing of Clostridium difficile infection.
abstract: Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhea and is associated with a considerable health and cost burden. However, there is still not a clear consensus on the best laboratory diagnosis approach and a wide variation of testing methods and strategies can be encountered.
  
  
  
  We aim to review the most practical aspects of CDI diagnosis providing our own view on how to optimize CDI diagnosis. Expert commentary: Laboratory diagnosis in search of C. difficile toxins should be applied to all fecal diarrheic samples reaching the microbiology laboratory in patients > 2 years old, with or without classic risk factors for CDI. Detection of toxins either directly in the fecal sample or in the bacteria isolated in culture confirm CDI in the proper clinical setting. Nuclear Acid Assay techniques (NAAT) allow to speed up the process with epidemiological and therapeutic consequences.
authors.affiliation: a Department of Clinical Microbiology and Infectious Diseases , Hospital General Universitario Gregorio Marañón , Madrid , Spain.|b Facultad de Medicina , Universidad Complutense de Madrid (UCM) , Madrid , Spain.|c Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain.|d CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058) , Madrid , Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.affiliation: a Department of Clinical Microbiology and Infectious Diseases , Hospital General Universitario Gregorio Marañón , Madrid , Spain.|d CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058) , Madrid , Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Alcalá
authors.affiliation: a Department of Clinical Microbiology and Infectious Diseases , Hospital General Universitario Gregorio Marañón , Madrid , Spain.|c Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Reigadas
mesh_terms: D000465:Algorithms; D001426:Bacterial Proteins / Q000235:genetics / Q000302:isolation & purification; D001427:Bacterial Toxins / Q000235:genetics / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000378:metabolism; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology*; D004768:Enterotoxins / Q000235:genetics / Q000302:isolation & purification; D005243:Feces / Q000737:chemistry / Q000382:microbiology*; D006801:Humans; D007124:Immunoenzyme Techniques; D025202:Molecular Diagnostic Techniques; D021141:Nucleic Acid Amplification Techniques; D013048:Specimen Handling
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile
keywords: Clostridium difficile; cell cytotoxicity assay; diagnostic algorithms; enzyme immune assay; laboratory diagnosis; nucleic acid amplification tests; toxigenic culture