title: Molecular techniques for diagnosis of Clostridium difficile infection: systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the usefulness of 2 rapid molecular diagnostic techniques, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), in Clostridium difficile infection (CDI).
  
  
  METHODS
  We conducted a systematic review and meta-analysis to evaluate the accuracy of PCR and LAMP in diagnosis of CDI, including studies that used toxigenic culture or cytotoxicity assay as reference standard.
  
  
  RESULTS
  A search of PubMed and CinAHL medical databases yielded 25 PCR studies, including 11,801 samples that met inclusion criteria and 6 heterogeneous studies that evaluated LAMP. With toxigenic culture as a standard, pooled sensitivity was 0.92 (95% confidence interval [CI], 0.91-0.94); specificity, 0.94 (95% CI, 0.94-0.95); and diagnostic odds ratio, 378 (95% CI, 260-547). With cytotoxicity as a standard, pooled sensitivity was 0.87 (95% CI, 0.84-0.90); specificity, 0.97 (95% CI, 0.97-0.98); and diagnostic odds ratio, 370 (95% CI, 226-606).
  
  
  CONCLUSIONS
  Polymerase chain reaction is a highly accurate test for identifying CDI. Heterogeneity in LAMP studies did not allow meta-analysis; however, further research into this promising method is warranted.
authors: Department of Graduate Medical Education, Aurora UW Medical Group, Milwaukee, WI, USA.
authors: John C
authors: JC
authors: O'Horo
authors: Amy
authors: A
authors: Jones
authors: Matthew
authors: M
authors: Sternke
authors: Christopher
authors: C
authors: Harper
authors: Nasia
authors: N
authors: Safdar
mesh_terms: D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D012372:ROC Curve; D012680:Sensitivity and Specificity