Laboratory diagnosis of Clostridioides dif f icile infection: guidelines and status of practice in Korea

Abstract

Clostridioides difficile infection (CDI) is a common healthcare-associated infection that is expected to increase with the increases in the elderly population, immunocompromised patients treated with chemotherapy and immunosuppressive drugs, antimicrobial-resistant bacteria, and invasive medical technologies. Accurate diagnosis is critical for proper treatment and management of CDI. Clinical laboratories typically use four methods to diagnose CDI: C. difficile culture, toxin detection using immunoassays, detection of glutamate dehydrogenase using immunoassays, and detection of toxin A/B gene. Each CDI diagnostic test has strengths and limitations, and varies in performance. Guidelines for CDI diagnosis have been developed by organizations that include the European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America/Society for Healthcare Epidemiology of America, and American College of Gastroenterology. Certain other countries have guidelines. In Korea, surveys on CDI diagnosis performed in 2015 and 2018 revealed a shift in CDI testing in clinical laboratories in Korea. It is necessary to develop standardized diagnostic guidelines for CDI appropriate for the Korean context.