Pragmatic strategy for fecal specimen storage and the corresponding testmethods for clostridioides difficile diagnosis

Seong Won Nho, Minjae Kim, Seong Jae Kim, Steven L. Foley, Rajesh Nayak, Ohgew Kweon, Carl E. Cerniglia

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The quality of fecal specimens is one of the factors responsible for successful Clostridioides difficile infection (CDI) diagnosis. The quality depends largely on the storage conditions, including the temperature and time period. In this study, we organized the outputs of previous studies, filled experimental gaps in the knowledge of storage conditions, and introduced a pragmatic strategy for fecal storage for CDI diagnosis. A 5-step pathway was adopted to develop the fecal specimen storage strategy as follows: step 1, bibliomic analysis; step 2, experimental gap-filling; step 3, comparative evaluation; step 4, strategy development; step 5, internal review. Step 1 identified eight articles providing experimental information on the effects of fecal specimen storage conditions on the effectiveness of C. difficile detection methods. Step 2 provided additional quantitative data on C. difficile vegetative and spore cell viability and DNA stability. All previous and current results were compared (step 3). In step 4, fir general and nine special strategies were developed, followed by an internal review of the overall approaches (step 5). It is recommended to separate fecal samples into aliquots before testing and storing them. It is particularly recommended that fecal specimen samples be stored for CDI diagnosis at 4C for up to 60 days for all test methods.

Original languageEnglish
Article number1049
Issue number8
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Bibliomic data
  • CDI diagnosis
  • Clostridioides difficile
  • Fecal specimen
  • Real-time PCR
  • Storage condition

ASJC Scopus subject areas

  • Immunology and Allergy
  • Molecular Biology
  • General Immunology and Microbiology
  • Microbiology (medical)
  • Infectious Diseases


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