Clinical recognition and diagnosis of Clostridium difficile infection

Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S12-8. doi: 10.1086/521863.


Prompt and precise diagnosis is an important aspect of effective management of Clostridium difficile infection (CDI). CDI causes 15%-25% of all cases of antibiotic-associated diarrhea, the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Several factors, especially advanced age and hospitalization, should be considered in the diagnosis of CDI. In particular, nosocomial diarrhea arising >72 hours after admission among patients receiving antibiotics is highly likely to have resulted from CDI. Testing of stool for the presence of C. difficile toxin confirms the diagnosis of CDI. However, performance of an enzyme immunoassay is the usual method by which CDI is confirmed, but this test appears to be relatively insensitive, compared with the cell cytotoxicity assay and stool culture for toxigenic C. difficile on selective medium. Endoscopy and computed tomography are less sensitive than stool toxin assays but may be useful when immediate results are important or other confounding conditions rank high in the differential diagnosis. Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Toxins / analysis
  • Bacterial Toxins / isolation & purification
  • Child
  • Child, Preschool
  • Clostridioides difficile*
  • Cytotoxicity Tests, Immunologic
  • Diagnostic Imaging / economics
  • Diagnostic Imaging / standards
  • Diarrhea / etiology
  • Diarrhea / microbiology
  • Enterocolitis, Pseudomembranous / complications
  • Enterocolitis, Pseudomembranous / diagnosis*
  • Enterocolitis, Pseudomembranous / microbiology
  • Enterocolitis, Pseudomembranous / physiopathology
  • Feces / microbiology
  • Humans
  • Immunoenzyme Techniques
  • Infant
  • Risk Factors


  • Anti-Bacterial Agents
  • Bacterial Toxins