A survey on Clostridioides difficile infection (CDI) testing in microbiology laboratories in Saudi Arabia: Findings and implications

Purpose: To investigate various critical elements of Clostridioides difficile infection (CDI) testing in laboratories in Saudi Arabia, encompassing diagnostic techniques employed, testing protocols, specimen handling procedures, result reporting practices, and resource availability. Method: A cross-sectional study was conducted via an online survey to assess CDI testing protocols and procedures employed by microbiologists in Saudi Arabia. The questionnaire examined various aspects of testing procedures, laboratory protocols, testing schedules, and obstacles to conducting CDI tests. Differences were compared using Chi-square. P < 0.05 was considered significant. Results: The survey elicited responses from 68 hospitals across 13 administrative regions of Saudi Arabia. A total of 52.9 % (n = 36) came from small hospitals (≤ 200 beds), distributed across 8 regions. The Western region contained the highest number of responding hospitals overall (44.1 %, n = 30). There was significant difference in positive CDI tests reported between large hospitals (> 200 beds; 59.4%, n = 19) and small hospitals (13.9 %, n = 5; p < 0.001). Among laboratories that test in-house, 22.7 % (n = 15) reported using nucleic acid amplification tests, 25.8 % (n = 17) reported sending stool specimens to external laboratories, 11.8 % (n = 8) reported using multistep methods, and 25.8 % (n =17) were unsure of the used tests. Limited institutional budget for CDI testing kits was the most commonly reported barrier by laboratory microbiologists. Conclusion: While CDI testing practices in Saudi Arabian microbiology laboratories generally align with international guidelines, this survey identifies opportunities for improvement through enhanced education, implementation of evidence-based testing algorithms, and addressing resource limitations.