Criteria for detection of Clostridium difficile toxin production by counterimmunoelectrophoresis

Counterimmunoelectrophoresis (CIE) was compared with a cytotoxicity assay and isolation of toxin-producing Clostridium difficile for the diagnosis of antibiotic-associated diarrhea. Standardized criteria for CIE positivity were established as two major precipitin lines with specific C. difficile antitoxin. Using these criteria on 425 fecal specimens, we determined the sensitivity of CIE (80%) to be comparable to that of the cytotoxicity assay (82%). Both methods were highly specific. With carefully controlled techniques, CIE can be used in routine diagnostic laboratories to screen for toxigenic C. difficile.