Clostridium difficile Diagnostics in Long-Term Care Facilities

  • Rishitha Bollam
  • Nisa Desai
  • Laurie Archbald-PannoneEmail author


Clostridium difficile (C. difficile) infection (CDI) is an increasing common healthcare-associated infection and disproportionally affects our elderly patients and patients in long-term care facilities (LTCFs) (Asempa and Nicolau, Clin Interv Aging. 12:1799, 2017). As described in other chapters of this book, patients with CDI can have multiple loose or watery stools in 1 day causing extreme dehydration, electrolyte disarray, sepsis, toxic megacolon, and even death. With the increasing prevalence and severity of CDI over the past decade, clinicians are understandably concerned when suspecting CDI in one of their patients and keen to test to see if C. difficile is present in the stool. However, the presence of C. difficile in the stool is not sufficient to diagnose CDI, and the current diagnostic tests commercially available are complex. CDI is a toxin-mediated infection and therefore, diagnostic assays often focus on the presence of toxin as a necessary component to develop infection, as opposed to colonization with non-toxigenic C. difficile strain. Nucleic acid amplification test (NAAT), enzyme immunoassay (EIA), and cytotoxigenic culture (CC) and cell cytotoxicity assay (CCTA) are available options. A multistep algorithmic approach has been recommended to utilize the above-mentioned testing. Diagnostics are challenged by decreased immune response in the elderly and delays in an LTCF setting. In this chapter, we will describe the different C. difficile diagnostic tests and their appropriate use in clinical practice in long-term care patients.


Clostridium difficile infection Long-term care facilities Diagnostics Elderly 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rishitha Bollam
    • 1
  • Nisa Desai
    • 1
  • Laurie Archbald-Pannone
    • 2
    • 3
    Email author
  1. 1.University of Virginia, School of Medicine, Department of Internal MedicineCharlottesvilleUSA
  2. 2.University of Virginia, School of Medicine, Department of Internal Medicine, Division of General, Geriatric, Palliative & Hospital MedicineCharlottesvilleUSA
  3. 3.University of Virginia, School of Medicine, Department of Internal Medicine, Division of General, Geriatric, Palliative & Hospital Medicine and Division of Infectious Diseases and International HealthCharlottesvilleUSA

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