ArticleBMC infectious diseases2026
Clinical outcomes of toxin-positive versus toxin-negative/NAAT-positive Clostridioides difficile infection in South Korea: a single-center retrospective cohort study.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines recommend multistep algorithms incorporating nucleic acid amplification tests (NAATs) and toxin enzyme immunoassays (EIAs) for the diagnosis of Clostridioides difficile infection (CDI); however, the clinical significance of toxin-negative/NAAT-positive (toxin-/NAAT+) results remains uncertain. We aimed to compare clinical outcomes between toxin + and toxin-/NAAT+ cases.
methodsThis retrospective study included adults diagnosed with CDI between September 2020 and September 2025 at a tertiary hospital in South Korea. Patients were classified by toxin EIA and NAAT results into toxin + or toxin-/NAAT+ groups, and their outcomes were compared. The primary outcome was CDI recurrence within 90 days. Secondary outcomes included 60-day recurrence, 90-day all-cause mortality, resolution of diarrhea, and colectomy for CDI.
resultsIn total, 382 toxin + and 435 toxin-/NAAT+ were evaluated. CDI recurred in 55 patients (6.7%), including 35 (9.2%) in the toxin+ group and 20 (4.6%) in the toxin-/NAAT+ group (P = 0.011). Toxin positivity was significantly associated with recurrence (adjusted odds ratio [aOR], 1.99; 95% confidence interval [CI], 1.12-3.52; P = 0.019). Prior antibiotic exposure was also associated with recurrence (aOR, 2.24; 95% CI, 1.25-4.02; P = 0.007). Toxin positivity was not associated with 90-day mortality (aOR, 1.19; 95% CI, 0.85-1.69; P = 0.313).
conclusionsIn our cohort, toxin positivity was associated with an increased risk of 90-day recurrence but not with 90-day mortality. Our data indicate that incorporation of toxin EIA testing into CDI diagnostic algorithms could provide clinically relevant prognostic information.
trial registrationNot applicable.
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