title: Concordance between two enzyme immunoassays for the detection of Clostridium difficile toxins.
abstract: OBJECTIVE
  The diagnosis of Clostridium difficile-associated disease (CDAD) is based on the detection of toxins from stool samples. There are several immunoassays for this purpose. The aim of this study was to determine the concordance between the two immunoassays and their performance in comparison to the toxigenic culture as part of the initial evaluation of a suspected case of CDAD.
  
  
  METHODS
  All fecal samples submitted for detection of C. difficile toxins during a 5-month period to our laboratory were analyzed by two immunoassays, VIDAS Toxin CDA/B assay (BioMerieux) and ImmunoCard Toxins A/B (Meridian Bioscience). We cultured on cycloserine-cefoxitin-fructose agar and PCR was used for detection of toxigenic genes. Real-time PCR was performed directly from samples to detect the tcdC gene.
  
  
  RESULTS
  At the end of the study we processed 230 samples, 13 were positive using VIDAS CDA/B (5.6%), and 14 using ImmunoCard A/B (6.0%); kappa coefficient was 0.857. With ImmunoCard A/B we obtained a sensitivity of 80%, a specificity of 99%, positive predictive value (PPV) 86% and negative predictive value (NPV) 98%, as compared to toxigenic culture. For VIDAS CDA/B we obtained a sensitivity of 90%, a specificity of 98%, PPV 69% and NPV 99%, compared to the same standard. There were seven undetermined results (3.0%) by VIDAS CDA/B. Five of these had a positive culture and all the patients had symptoms of CDAD. Considering these undetermined results as positive, we calculated a sensitivity of 93%, specificity of 97%, PPV 71% and NPV of 99% for this test, and a kappa of 0.856. Both immunoassays showed similar results and are suitable for the initial evaluation of patients with suspected CDAD.
  
  
  CONCLUSIONS
  Our data suggest that an undetermined result of VIDAS CDA/B should be considered as positive if CDAD is suspected. Additionally, both immunoassays showed similar results and are suitable for the initial evaluation of patients with suspected CDAD.
authors.affiliation: Laboratory of Clinical Microbiology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
authors.forename: Jaime O
authors.initials: JO
authors.lastname: Herrera-Cáceres
authors.forename: Adrián
authors.initials: A
authors.lastname: Camacho-Ortiz
authors.forename: Arturo
authors.initials: A
authors.lastname: Galindo-Fraga
authors.forename: Melissa
authors.initials: M
authors.lastname: Hernández-Durán
authors.forename: Andrea
authors.initials: A
authors.lastname: Cordero-Rangel
authors.forename: Araceli
authors.initials: A
authors.lastname: Hernández-Cruz
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla-del Valle
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-de-León
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
mesh_terms: D000818:Animals; D001427:Bacterial Toxins / Q000378:metabolism*; D016360:Clostridioides difficile / Q000737:chemistry*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis; D005243:Feces / Q000737:chemistry; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D001427:Bacterial Toxins