Because nucleic acid amplification tests (NAATs) do not distinguish Clostridium difficile infection (CDI) and asymptomatic C. difficile carriage, the diagnostic predictive value of NAATs is limited when used in patients with a low probability of CDI.

There is an abundance of evidence suggesting that inappropriate use of C. difficile NAATs in low-risk populations reduces the assay diagnostic predictive value and leads to CDI misdiagnosis and unnecessary treatment. Furthermore, because health care-associated infection (HAI) rates are an important hospital quality metric, and with the threat of hospital nonreimbursement for HAIs such as CDI, hospitals have a financial incentive for accurately measuring and avoiding overestimation of CDI rates.

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