Table 2

- Simplified comparison of various laboratory detection methods for the detection of Clostridioides difficile infection.

Techniques	Criteria						Advantages	Limitations	References
Techniques	Simple to perform	Simple to interpret	Specimen type	Turnaround time	Sensitivity (%)	Specificity (%)	Advantages	Limitations	References
TC	Good	Good	Stool	2-7 days	High	Low	Due to its high sensitivity, it is recommended as a reference method; it allows performing strain typing and antimicrobial suitability test	Long turnaround time; need to be combined with another method	8,18,85
CTA	Fair	Good	Stool filtrate	48-72 hours	High	High	Has acceptable sensitivity and specificity, and it is inexpensive	Labor-intensive, long turnaround time, and lack of harmonization	18,85,86
EIA for detecting GDH	Good	Good	Stool	Rapid 2-6 hours	Low	Low	Quick to produce results, and simple to use	Lacks specificity, high false-positive rate, and should be used in combination with another method	8,18,85,87
EIA for detecting toxins A or B	Good	Good	Stool	Rapid 2-6 hours	Low	Moderate	Quick to produce results, and simple to use	Insensitive enough in the detection of toxin-producing isolates of C. difficile in comparison to other techniques such as TC or CTA. High false-negative rate	8,18,85,87
NAAT	Good	Good	Stool	Rapid 2 hours	High	Low/moderate	Rapid and highly sensitive	Identify carriers of toxigenic C. difficile who have no symptoms. Genetic variation in tcdB or tcdA genes might lead to false-negative results. Expensive	8,85,87,90

TC: toxigenic culture, CTA: cell cytotoxicity assay, GDH: glutamate dehydrogenase, NAAT: nucleic acid amplification test, EIA: enzyme immunoassay