Clostridioides difficile infection (CDI) is a significant healthcare-associated condition that also impacts the pediatric population, especially given the high prevalence of asymptomatic colonization among young children. Diagnosing CDI in children is challenging due to the frequent presence of both non-toxigenic and toxigenic C. difficile strains, particularly in infants, which complicates the interpretation of laboratory tests. This study evaluates diagnostic methods, including toxigenic culture, enzyme immunoassays (EIAs), glutamate dehydrogenase (GDH) immunoassays, and nucleic acid amplification tests (NAATs), finding that none offer a perfect balance of sensitivity, specificity, speed, and cost.
NAATs and GDH immunoassays provide high sensitivity but lack specificity, while toxin immunoassays are specific but less sensitive. Guidelines from ESCMID and IDSA recommend multistep diagnostic algorithms combining initial sensitive tests with confirmatory assays to improve accuracy. This study also suggests that adopting stricter criteria for testing—such as limiting tests to patients with high pre-test probability of CDI—could enhance the reliability of pediatric CDI diagnostics and prevent unnecessary treatment.
Reference: Suleiman M, Tang P, Imam O, et al. Clostridioides difficile Infections in Children: What Is the Optimal Laboratory Diagnostic Method? Microorganisms. 2024 Aug 28;12(9):1785. doi: 10.3390/microorganisms12091785. PMID: 39338460; PMCID: PMC11434531.
