Recurrent Clostridioides difficile infection: Recognition, management, prevention

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Figure 1
Antibiotic therapy can paradoxically lead to recurrent Clostridioides difficile infection by disrupting the normal colonic microbiota.
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Figure 2
Photomicrograph showing the presence of Clostridioides difficile bacteria, many of which have assumed an endospore morphology. This is from a blood agar impression smear incubated for 72 hours anaerobically.
From the US Centers for Disease Control and Prevention, Dr. Gilda Jones; Public Domain; Available at: https://phil.cdc.gov/phil/details.asp?pid=3876
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Figure 3
Fecal microbiota transplantation involves instilling fecal material from a healthy donor to restore the normal intestinal flora.

TABLE 1

Diagnostic tests for Clostridioides difficile

Test	Characteristics	Sensitivity, specificity
Organism detection assays
Nucleic acid amplification tests (eg, polymerase chain reaction)	Detects toxin gene (ie, organism) but not toxins	High sensitivity Low to moderate specificity
Glutamate dehydrogenase	C difficile common antigen	High sensitivity Low specificity
Toxigenic C difficile culture	Growth of C difficile organism Testing not readily available Slow turnaround time	High sensitivity Low specificity

Toxin detection assays
Enzyme immunoassay	Detects free toxins	Low sensitivity Moderate specificity
Cell culture cytotoxicity neutralization assay	Detects free toxins Lacks standardization Slow turnaround time	High sensitivity High specificity, if optimized