Systematic review: Accuracy of diagnostic methods for Clostridioides difficile infection

Area of Science:

• Infectious Diseases
• Diagnostic Accuracy
• Microbiology

Background:

• Clostridioides difficile infection (CDI) diagnosis faces challenges due to the lack of a definitive gold standard.
• Various diagnostic methodologies exist, each with varying accuracy and clinical utility.

Purpose of the Study:

• To systematically review and analyze the diagnostic accuracy of methodologies for Clostridioides difficile infection (CDI).
• To compare the performance of different diagnostic tests used for CDI detection.

Main Methods:

• A systematic review of Medline, Embase, and Lilacs databases was conducted.
• Included studies evaluated diagnostic methods like toxigenic culture (TC), latex agglutination (LA), cell cytotoxicity neutralization assay (CCNA), enzyme immunoassay (EIA), and nucleic acid amplification tests (NAAT).
• Study quality was assessed using QUADAS-2 and QUADAS-C, evidence quality using GRADE, and meta-analysis (MA) was performed.

Main Results:

• 170 studies were included, with 79 entering the meta-analysis, covering over 98,000 samples.
• Molecular methods (NAAT) showed high accuracy for identifying toxins A and B.
• Enzyme immunoassay for GDH demonstrated effectiveness as a screening tool with 91.6% sensitivity.

Conclusions:

• CDI diagnostics remain complex without a universally accepted gold standard.
• Enzyme immunoassays (EIA) and nucleic acid amplification tests (NAAT) have significantly advanced CDI diagnostics, providing higher accuracy and faster results.