title: PROSPECTIVE EVALUATION OF A NOVEL TWO-STEP PROTOCOL FOR SCREENING OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED ADULT PATIENTS.
abstract: Abstract. Clostridium difficile infection (CDI) is one of the most common nosocomial infections in Thailand and worldwide. The clinical spectrum ranges from annoy- ing diarrhea to severe life-threatening disease. Enzyme-linked immunofluorescent assay for cytotoxins A/B (cytotoxins A/B ELFA), which has been widely used in our institute, generally is considered as having low sensitivity for diagnosis of CDI. The study was a prospective evaluation of a novel two-step diagnostic algorithm, in which the first step involved concurrent cytotoxins A/B ELFA and enzyme immunoassay for glutamate dehydrogenase (GDH EIA) for CDI, followed by PCR assay of tcdA and tcdB in samples with discordant results. Of the 91 adult patients (37 males and 54 females, mean age of 60.0 ± 19.5 years) with suspected CDI hospitalized at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from December 2012 to February 2013, 22 were diagnosed with CDI by the gold standard PCR test for tcdA and tcdB, among whom 21 were positive by GDH EIA, accounting for a sensitivity of 95%. Of the 69 patients without CDI, GDH EIA was negative in 46 patients, accounting for a specificity of 67%. The positive predic- tive value (PPV), negative predictive value (NPV) and accuracy of GDH EIA was 48%, 98% and 74%, respectively, whereas sensitivity, specificity, PPV, NPV, and accuracy of cytotoxins A/B ELFA was 73%, 96%, 84%, 92% and 92%, respectively. Some 30% of specimens required the more expensive PCR assay. However, this two-step protocol detected 20% more patients with CDI than the currently used cytotoxins A/B ELFA method.
authors: Ratima
authors: R
authors: Issarachaikull
authors: Mayuree
authors: M
authors: Khantipong
authors: Ajcharaporn
authors: A
authors: Sawatpanich
authors: Chusana
authors: C
authors: Suankratay
mesh_terms: D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics*; D001427:Bacterial Toxins / Q000032:analysis*; D016360:Clostridioides difficile / Q000201:enzymology / Q000235:genetics*; D003015:Clostridium Infections / Q000175:diagnosis; D003428:Cross Infection; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000201:enzymology / Q000382:microbiology; D005260:Female; D005969:Glutamate Dehydrogenase / Q000032:analysis*; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013785:Thailand
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005969:Glutamate Dehydrogenase