A superior test for diagnosis of Clostridium difficile-associated diarrhea in resource-limited settings.
In this prospective cohort study, we investigated the prevalence of Clostridium  difficile-associated diarrhea (CDAD) in adult patients with nosocomial diarrhea by performing enzyme  immunoassay (EIA) for detecting toxins A and B and polymerase chain reaction (PCR) for detecting the  presence of the tcdB gene in stool samples. We determined the factors associated with CDAD, and the  treatment outcome of CDAD from May 2010 to January 2011. A total of 175 stool samples were tested by  EIA and PCR. In total, 26.9% patients tested positive for C. difficile: 12.6% by EIA and 24.0% by PCR.  The kappa coefficient and total agreement of both the tests were 0.46 and 83.2%, respectively. Onset of  diarrhea after antibiotic administration for 10 days or more (OR, 2.71; 95% CI, 1.14-6.44; P = 0.024)  and leukocyte count >15,000 cells/mm(3) (OR, 3.12; 95% CI, 1.24-7.88; P = 0.016) were significantly  associated with occurrence of CDAD. The non-response rate to CDAD treatment was 24.1%, and the  all-cause mortality rate was 31.9% in the CDAD group as against 35.9% in the non-CDAD group  (P = 0.721). In our study, the performance of direct PCR of stool samples for detecting tcdB was  better, with the number of positive results for stool toxins A and B being twofold higher than that  in the case of EIA. Patients who have diarrhea after receiving antibiotics for 10 days or more or  those who have a leukocyte count of >15,000 cells/mm(3) should be investigated for CDAD.
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Darunee
D
Chotiprasitsakul
Tavan
T
Janvilisri
Sasisopin
S
Kiertiburanakul
Siriorn
S
Watcharananun
Surang
S
Chankhamhaengdecha
Piyapong
P
Hadpanus
Kumthorn
K
Malathum
D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics / Q000276:immunology; D001427:Bacterial Toxins / Q000235:genetics / Q000276:immunology; D016360:Clostridioides difficile / Q000235:genetics* / Q000276:immunology*; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology; D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D001426:Bacterial Proteins; D001427:Bacterial Toxins; C031815:toxB protein, Clostridium difficile