Pathology consultation on detection of Clostridium difficile

Laboratory methods for detecting Clostridium difficile have undergone considerable evolution since the organism's etiologic association with antibiotic-associated diarrhea and colitis was established. Clearly, familiarity with the advantages and shortcomings of the various assays is essential for the laboratory director when choosing among these tests. For the consulting pathologist, furthermore, an understanding of the laboratory's role in securing a diagnosis of C difficile infection (CDI) is also required to identify requests for unnecessary testing that may be costly and potentially misleading. The purpose of this article is to highlight the major differences in laboratory test methods for CDI and to review a few commonly encountered provider ordering scenarios.