C. difficile associated diarrhoea (CDAD) remains a problematic infection typically associated with hospitalization and prior antimicrobial use. The global epidemiology of CDAD is a changing landscape and is complicated by issues surrounding accurate diagnosis . There are many diagnostic assays available ranging from enzyme immunoassays (EIA) to nucleic acid amplification tests (NAAT), however the gold standard tests (cell cytotoxin assay and cytotoxigenic culture) for diagnosis are rarely utilized due to the complex nature and prolonged turnaround times of these assays. Furthermore numerous algorithms are employed with a subsequent lack of standardization in testing methodology . In South Africa there is limited data on the epidemiology and in terms of diagnostics a move away from stand-alone EIA to NAAT, principally polymerase chain reaction (PCR), has transpired. This was secondary to the well-established poor sensitivity of stand-alone toxin detection assays in general, with failure to detect up to 20% of cases . However, NAAT as a stand-alone test is also contentious and thus not universally agreed upon as a standard for diagnosis of CDAD. Accurate diagnosis is essential to understanding both the epidemiology and clinical relevance of C. difficile infection (CDI) and thus it is evident that C. difficile diagnostics requires refinement. 

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