Clostridium difficile-Diagnostic and Clinical Challenges

Many studies published in the 1980s made the point that EIAs for detection of C. difficile toxins were not as sensitive as the cytotoxicity assay, and that the cytotoxicity assay was not as sensitive as toxigenic culture, yet laboratories blindly proceeded on using an insensitive EIA test. [...]the lack of sensitivity of toxin EIAs precludes their use as standalone tests.\n In the case of C. difficile, this may mean reducing use of cephalosporins to which C. difficile is intrinsically resistant, or using fewer macrolide-lincosamide or fluoroquinolone antibiotics, which appear to be the most common drugs to which resistance develops in C. difficile. In some studies, recent antibiotic exposure is documented to be ^50% of children with CA-CDI. Because the majority of children with CDI are classified as having CA-CDI, these data suggest that, compared to adults, antibiotic stewardship programs (ASPs) may not be as beneficial for CDI prevention in children.