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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
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.
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.
