title: [Rapid-tests detection evaluation of Clostridium difficile toxins and microbiological investigation].
abstract: We evaluated two rapid toxin tests for C. difficile combined with stool specimen cultures used from January 2006 to March 2009. Stool specimens numbered 877, 102 among which were from the cases of diagnosed clinical C. difficile-associated diarrhea (CDAD). Rapid toxin A 'Uniquick' detection kits were used until October 2007 and toxin A&B 'TOX A/B' detection kits thereafter. Clinical CDAD was considered the detection gold standard. Uniquick sensitivity, specificity, and positive and negative predictive values were 54.3%, 99.1%, 90.5%, and 93.2% while those for TOX A/B were 46.2%, 97.6%, 65.2%, and 95.0% and for culture 42.2%, 95.5%, 55.1%, and 92.6%. Rapid toxin tests tended to have better sensitivity than culture results although not significantly so, and Uniquick showed significantly better positive predictive value than TOX A/B or culture results. Among clinical CDAD cases, concordance with culture was 24.3% for Uniquick and 53.1% for TOX A/B. For stored strains, 27 were typed toxin A+B+ (48.1%), toxin A-B+ (37.0%) and toxin A-B- (14.8%) with toxin gene detection by PCR. Eight of the 10 toxin A-B+ strains were classified into two cluster by ribotyping, and 7 of those were detected in two hospital wards, indicated the possibility of nosocomial toxin A-B+ strain spread. The rapid toxin test for both toxins A and B should be used if toxin A-B+ predominate. Simultaneous culture testing may be useful for detecting clinical CDAD more accurately, however.
authors.affiliation: Department of Infection Control & Prevention, Kyoto University Hospital.
authors.forename: Risa
authors.initials: R
authors.lastname: Nakagawa
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iinuma
authors.forename: Masaki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Michinori
authors.initials: M
authors.lastname: Shirano
authors.forename: Aki
authors.initials: A
authors.lastname: Matsushima
authors.forename: Miki
authors.initials: M
authors.lastname: Nagao
authors.forename: Takashi
authors.initials: T
authors.lastname: Saito
authors.forename: Shunji
authors.initials: S
authors.lastname: Takakura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Higuchi
authors.forename: Michio
authors.initials: M
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama
mesh_terms: D001427:Bacterial Toxins / Q000032:analysis*; D001431:Bacteriological Techniques; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis*; D005243:Feces / Q000737:chemistry; D006801:Humans
chemical_list: D001427:Bacterial Toxins