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Updated: Apr 4, 2026

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Relationship Between Clostridioides difficile Stool Concentration, Nucleic Acid Amplification Test Results, and

Mary Morgan Lee1, Kimberly A Reske1, Tiffany Hink1

  • 1Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

Open Forum Infectious Diseases
|April 3, 2026
PubMed
Summary

Nucleic acid amplification testing (NAAT) of rectal swabs showed low sensitivity for detecting *Clostridioides difficile* colonization. However, patients with toxigenic *C. difficile* in stool were more likely to contaminate the hospital environment.

Keywords:
clostridioides difficilecolonizationenvironmental contaminationnucleic acid amplification testingstool culture

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Diagnostics

Background:

  • Clostridioides difficile infection (CDI) is a significant healthcare-associated pathogen.
  • Accurate detection of C. difficile colonization is crucial for infection control.
  • Environmental contamination plays a role in C. difficile transmission.

Purpose of the Study:

  • To compare the sensitivity of rectal swab NAAT versus stool culture for detecting C. difficile colonization.
  • To correlate C. difficile detection in patients with environmental contamination in a hospital setting.

Main Methods:

  • Rectal swab samples were tested using NAAT.
  • Stool samples were cultured for toxigenic C. difficile.
  • Environmental swabs were collected and tested for C. difficile.

Main Results:

  • Rectal swab NAAT demonstrated low sensitivity (43%) for detecting toxigenic C. difficile colonization.
  • Patients positive for toxigenic C. difficile via stool culture were significantly more likely to have C. difficile detected in their hospital environment.

Conclusions:

  • Rectal swab NAAT is not a sensitive method for detecting C. difficile colonization.
  • Identifying colonized patients with toxigenic C. difficile is important for environmental monitoring and infection control.