Battleground Zero: A Review of Best Practice Recommendations for Clostridioides (Clostridium) difficile Testing

Diagnosing Clostridioides (formerly Clostridium) difficile infection can be difficult, especially when there is a lack of consensus in the definition, disagreement on the gold standard, and indecision as to which is the best testing method. As laboratorians, we look to published best practice documents for guidance, but oftentimes, the recommendations are not straightforward. This article reviews the most recent guidance documents published by the Infectious Diseases Society of America/Society of Healthcare Epidemiology of America, the American College of Gastroenterology, the European Society of Clinical Microbiology and Infectious Diseases, and the American Society for Microbiology. Recommendations for the desired testing population, most accurate diagnostic test or testing algorithm, and frequency of testing are compared between the societies. A review of the guidance methodologies is provided, and strategies for laboratory adoption are discussed.