Usefulness of simultaneous detection of toxin A and glutamate dehydrogenase for the diagnosis of Clostridium difficile-associated diseases.
The aim of this study was to evaluate an immunoassay (Triage; Biosite Diagnostics, BMD, France) for detecting both a specific antigen of Clostridium difficile (glutamate dehydrogenase [GDH]) and toxin A. Evaluation of the test was carried out in 304 fecal samples from patients suspected of having Clostridium difficile-associated diseases. The results with GDH and toxin A were compared with those of a culture and cytotoxicity assay (toxin B). The prevalence rates for toxin B-positive and culture-positive fecal samples were 11.2% and 25%, respectively. The sensitivity of the Triage immunoassay was 90.8% for GDH and 79.4% for toxin A. A negative result with both toxin A and GDH was very reliably able to eliminate a diagnosis of Clostridium difficile-associated disease (negative predictive value 99.6%). Triage is a very rapid (20 min) and easy-to-perform test. It could be useful for diagnostic purposes and also for detecting nontoxigenic strains in epidemiogical studies.
Barbut
F
F
Service de Bactériologie-Virologie, Hôpital Saint-Antoine, Assistance-Publique-Hôpitaux de Paris, France. frederic.barbut@sat.ap-hop-paris.fr
Lalande
V
V
Daprey
G
G
Cohen
P
P
Marle
N
N
Burghoffer
B
B
Petit
J C
JC
D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis* / Q000276:immunology; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis*; D004768:Enterotoxins / Q000032:analysis* / Q000276:immunology; D005243:Feces / Q000382:microbiology; D005969:Glutamate Dehydrogenase / Q000032:analysis* / Q000276:immunology; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D005969:Glutamate Dehydrogenase