Analysis index

Cherry-sized stool sample or a minimum of 1 ml liquid stools (GDH-EIA; cytotoxin-B-/TcdB-PCR), 1 ml bowel secretion (cytotoxin-B-/TcdB-PCR)

Suspicion of clostridium difficile associated diarrhea (CDAD) or pseudomembranous enterocolitis, especially after previous antibiotic therapy (days-weeks)

As per § 6, section 1 IfSG (Infectious disease act) mandatory reporting applies in case of either illness or death, caused by clostridium difficile infection with a severe clinical course. A severe clinical course of clostridium difficile infection is given, when:

1. The infected person is admitted to hospital for the treatment of a community-acquired clostridium difficile infection,
2. The infected person is transferred to ICU for the treatment of clostridium difficile infection of its complications,
3. A surgical procedure, such as colectomy, due to megacolon, perforation or refractory colitis is performed, or when
4. The infected person passes away within 30 days after initial diagnosis of clostridium difficile infection and the infection is deemed the direct cause of death or at least having contributed to the death.

In humans, the clostridium difficile pathogen is often found in the intestines of small children (up to 80 %) and comparatively rarely in the intestines of adults (≤ 5 %).

Clostridium difficile associated diarrhea / pseudomembranous colitis mainly occurs after antibiotic therapy with clindamycin, cephalosporin, older quinolones (especially ciprofloxacin), but also amoxiclav. Antibiotic therapy may be as long as days to several weeks ago. Older, multimorbid patients are especially at risk.

Laboratory-diagnostically, initial testing for the clostridium difficile antigen GDH (glutamate dehydrogenase) via EIA is done. This test method has high negative predictive value. A negative test result near enough rules out clostridium difficile infection. In case of extreme clinical suspicion of CDAD, the sensitivity of this method can be increased by sending in several stool samples. In case of positive findings in the GDH-EIA, confirmation via PCR on cytotoxin B (TcdB) is sought. It has to be considered, that following adequate therapy and after cessation of symptoms, in 30 % of patients, toxin detection remains positive. It is not possible to draw a conclusion from this about potential infectiousness. According to recommendations of the RKI, isolation measures should be kept up for 48 hours after diarrhea has ceased. Therefore, a laboratory checkup is unnecessary after cessation of symptoms. However, the illness is prone to recurrences, thus relevant diagnostics may be necessary in case of reoccurring symptoms.