Multistep algorithm testing accurately identifies C. Diff patients who need treatment

Recognition of C. difficile as an emerging pathogen quickly coalesced with the appearance of the hypervirulent strain 027, a fluoroquinolone-resistant strain of C. difficile that generally produces more toxin and grows to higher numbers in the intestine than other strains. Because of these increased virulence traits (primarily antibiotic resistance), 027 spread quickly among medical facilities, moving from Europe to Canada and then to the U.S. With the spread of 027, the overall incidence of C. difficile began to increase dramatically. [...]a patient's chance of picking up C. difficile in the hospital and carrying it asymptomatically is greater than developing active CDI while in the hospital. * C. difficile can be carried in persons who have diarrhea caused by norovirus or Campylobacter or any one of a number of other infections or conditions (for example, other intestinal pathogens, inflammatory bowel disease), but not be involved in causing the diarrhea. * C. difficile can be a passive bystander in patients with diarrhea for a host of other reasons including laxative use, chemotherapy, liquid diets, stress, and pharmaceutical side effects. [...]due to the prevalence of carriers, accurately identifying patients who have true CDI and need treatment remains a significant challenge. NAAT tests do not detect toxin, nor do they demonstrate that toxin is being produced and is present in the specimen. Since roughly half of the patients colonized with C. difficile are not colonized with strains producing toxin, this high sensitivity for the toxin gene(s) results in the overdiagnosis of CDI in hospitals, leading to treatment, including antibiotic usage, of patients who do not need treatment.