Grant: Operating Grant: Antimicrobial Resistance

Clostridium difficile is a germ that produces toxins resulting in diarrhea that ranges from mild to severe. C. difficile is usually acquired in hospitals in approximately 80-90% of cases with the remaining 10-20% occurring in the community milieu. Approximately 5% of healthy individuals and up to 50% of hospitalized patients may carry this germ in their intestines without any symptoms. Accurate and rapid diagnosis of C. difficile infection is crucial because test results have implications for timely treatment and for measures required to prevent its spread. Current diagnostic tests vary in performance and are currently inadequate to differentiate those individuals who truly have disease from those who simply carry the germ without symptoms. Recently, a new promising technology has been developed that detects and measures the quantity of toxin produced by this germ. This test has been validated on patients with C. difficile infection but not on those who are carriers. Furthermore, the traditional sample for C. difficile testing has been stool. However, collecting stool is cumbersome and messy for patients, caregivers and nursing personnel. Rectal swabs have been studied in a small number of patients and appear to be just as good as stool specimens in C. difficile detection. We would like to evaluate this new test and compare it with other gene-based diagnostic methods as well as other traditional tests on both stool and rectal swab specimens. We anticipate that this test may be able to distinguish patients who have disease from those who are carriers of the germ because of its quantitative element. Furthermore, we expect that testing of rectal swabs will prove to be an accurate and efficient method of detecting C. difficile infection. The results of this study would lead to more appropriate therapy for patients who really have disease, to more appropriate and effective use of infection control measures and would help patients in specimen collection.