title: Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?
abstract: INTRODUCTIONIn 2010, we published an initial Point-Counterpoint on the laboratory diagnosis ofClostridium difficileinfection (CDI). At that time, nucleic acid amplification tests (NAATs) were just becoming commercially available, and the idea of algorithmic approaches to CDI was being explored. Now, there are numerous NAATs in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for CDI diagnosis in the United States. At the same time, there is a body of literature that suggests that NAATs lack clinical specificity and thus inflate CDI rates. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing; hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint using a frequently asked question approach, Ferric Fang of the University of Washington, who has been a consistent advocate for a NAAT-only approach for CDI diagnosis, will discuss the value of a NAAT-only approach, while Christopher Polage of the University of California Davis and Mark Wilcox of Leeds University, Leeds, United Kingdom, each of whom has recently written important articles on the value of toxin detection in the diagnosis, will discuss the impact of toxin detection in CDI diagnosis.
authors.affiliation: Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, USA fcfang@u.washington.edu christopher.polage@ucdmc.ucdavis.edu.
authors.forename: Ferric C
authors.initials: FC
authors.lastname: Fang
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California, USA fcfang@u.washington.edu christopher.polage@ucdmc.ucdavis.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Polage
authors.affiliation: Leeds Teaching Hospitals, NHS Trust, and University of Leeds, Leeds, United Kingdom.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
mesh_terms: D019411:Clinical Laboratory Techniques / Q000379:methods*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis*; D006801:Humans; D006113:United Kingdom; D014481:United States
keywords: Clostridium difficile; NAAT; confirmatory test; diagnosis; glutamate dehydrogenase; screening test; toxin