Page updated 5th March 2007
3.0. Diagnosis of Clostridium difficile
Infection with C.difficile is routinely diagnosed by detection of toxins A & B in faeces. Culture is not normally undertaken. Loose stools from patients over 65 years will be tested for C. difficile toxins (CDT) routinely as part of the National Healthcare Associated Infection Surveillance programme. In all other patients, specimens of diarrhoeal stool will only be tested if specifically requested. Stools from children below 1 year are not normally tested for this organism.
C.difficile toxin tests should be requested in patients with diarrhoea in the following situations:
- The patient is on or has been on antibiotics in the past 4 weeks.
- There is severe diarrhoea, fever, bloody stools or severe abdominal cramps.
- When previous cultures of stools are negative, but symptoms persist.
- The patient developed diarrhoea whilst there was an existing case nearby.
3.1 Clearance and repeat specimens
There is no need to send further specimens once C. difficile has been diagnosed unless:
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Symptoms persist despite treatment when a further test may be undertaken after 4 weeks.
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Symptoms resolve and then recur which may suggest a relapse which occurs in about 20-30 of patients. Sometimes this is due to acquisition of a new strain.
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