Evaluation of the diagnostic algorithm consisting of enzyme immunoassay for toxins and polymerase chain reaction, for the diagnosis of Clostridium difficile-associated diarrhoea.
A total of 1631 stool specimens were tested for Clostridium difficile toxins A and B using an enzyme immunoassay (EIA). C. difficile toxin was detected in 191 (11.7%, 191/1631) cases by EIA. Among the remaining 1440 cases, 102 cases in patients with either antibiotic-associated diarrhoea or hospitalized patients with unexplained leukocytosis (> 15,000/mm³) and fever (≥ 38°C) even though they did not meet the criteria for diarrhoea, were further assessed using a polymerase chain reaction (PCR) for the toxin B gene (tcdB). Thirty-four cases were tcdB-positive (33.3%, 34/102). A total of 225 cases (13.8%, 225/1631) had a stool test result positive for C. difficile toxins. Among these, 145 cases were diagnosed with C. difficile-associated diarrhoea (CDAD): 80.7% (117/145) using the EIA and 19.3% (28/145) using the PCR. In our study, the 2-test algorithm including EIA-toxin assay and PCR test made a more accurate diagnosis of CDAD. Furthermore, the application of clinical situations may be effective in the selection of patients who need confirmatory testing.
Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea. john7026@wku.ac.kr
Jae Hoon
JH
Lee
Seung Jin
SJ
Park
Yu Min
YM
Lee
Chang Hoon
CH
Lee
Ji Hyun
JH
Cho
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001427:Bacterial Toxins / Q000032:analysis; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000382:microbiology; D004269:DNA, Bacterial / Q000302:isolation & purification; D003967:Diarrhea / Q000175:diagnosis* / Q000382:microbiology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*
D001427:Bacterial Toxins; D004269:DNA, Bacterial