Clostridium difficile toxin testing by National Health Service (NHS) acute Trusts in England: 2008-2013

Clin Microbiol Infect. 2015 Sep;21(9):850.e1-4. doi: 10.1016/j.cmi.2015.04.013. Epub 2015 May 8.


In October 2007, a governmental 3-year target to reduce Clostridium difficile infection (CDI) by 30%, with financial penalties levied for failure, was introduced in England. This target was met within just 1 year, leading to speculation of 'gaming', with hospitals empirically treating possible CDI in the absence of a microbiological diagnosis, to avoid having to report confirmed cases. An analysis of aggregate mandatory data on levels of testing for C. difficile toxin showed little evidence of a fall in testing during the steepest infection rate reductions, suggesting that this was not a major factor in the decline in CDI.

Keywords: Clostridium difficile; England; objectives; stool samples; toxin testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacterial Toxins / analysis*
  • Child
  • Child, Preschool
  • Clostridioides difficile / isolation & purification*
  • Clostridium Infections / diagnosis*
  • Clostridium Infections / epidemiology
  • Clostridium Infections / microbiology*
  • England / epidemiology
  • Enterocolitis / diagnosis*
  • Enterocolitis / epidemiology
  • Enterocolitis / microbiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Prevalence
  • Young Adult


  • Bacterial Toxins