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Year 2016, Volume: 33 Issue: 1, 80 - 86, 01.01.2016

Abstract

References

  • 1. Thielman NM, Wilson KH: Antibiotic-associated colitis. In Principles and Practice of Infectious Diseases. 7th press. Benett (ed) Mandell GL, JE Dolin R. (eds), Churchill Livingstone, New York 2010. [CrossRef
  • 2. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015;313:398-408. [CrossRef]
  • 3. Rodriguez C, Korsak N, Taminiau B, Avesani V, Van Broeck J, Delmée M, et al. Clostridium difficile infection in elderly nursing home residents. Anaerobe 2014;30:184-7. [CrossRef]
  • 4. Tunçcan OG, Ulutan F, Karakuş R. The frequency of Clostridium difficile toxin in neutropenic and non-neutropenic patients with antibiotic-associated diarrhea and analysis of the risk factors. Mikrobiyol Bul 2008;42:573-83.
  • 5. Freeman J, Bauer MP, Baines SD, Corver J, Fawley WN, Goorhuis B, et al. The Changing Epidemiology of Clostridium difficile Infections. Clin Microbiol Rev 2010;529-49. [CrossRef]
  • 6. Crobach MJ, Dekkers OM, Wilcox MH, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect 2009;15:1053-66. [CrossRef]
  • 7. Merz CS, Kramer C, Forman M, Gluck L, Mills K, Senft K, et al. Comparison of four commercially available rapid enzyme immunassays with cytotoxin assay for detection of Clostridium difficile toxin(s) from stool specimens. J Clin Microbiol 1994;32:1142-7.
  • 8. Alcalá L, Sánchez-Cambronero L, Catalán MP, Sánchez-Somolinos M, Peláez MT, Marín M, et al. Comparison of three commercial methods for rapid detection of Clostridium difficile toxin A and B from fecal specimens. J Clin Microbiol 2008;46:3833-5. [CrossRef]
  • 9. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of real time PCR for detection of the tcdC gene with four toxin immunassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol 2008;46:1996-2001. [CrossRef]
  • 10. Altindis M, Usluer S, Ciftçi H, Tunç N, Cetinkaya Z, Aktepe OC. Investigation of the presence of Clostridium difficile in antibiotic associated diarrhea patients by culture and toxin detection methods. Mikrobiyol Bul 2007;41:29-37.
  • 11. Oldfield EC. Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment. Rev Gastroenterol Disord 2004;4:186-95.
  • 12. Zheng L, Keller SF, Lyerly DM, Carman RJ, Genheimer CW, Gleaves CA, et al. Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens. J Clin Microbiol 2004;42:3837-40. [CrossRef]
  • 13. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:5. [CrossRef]
  • 14. LaSala PR, Svensson AM, Mohammad AA, Perrotta PL. Comparison of Analytical and Clinical Performance of Three Methods for Detection of Clostridium difficile. Arch Pathol Lab Med 2012;136:527-31. [CrossRef]
  • 15. Fenner L, Widmer AF, Goy G, Rudin S, Frei R. Rapid and reliable diagnostic algorithm for detection of Clostridium difficile. J Clin Microbiol 2008;46:328-30. [CrossRef]
  • 16. Williamson DA, Basu I, Freeman J, Swager T, Roberts SA. Improved detection of toxigenic C. difficile using the Cepheid Xpert C. difficile assay and impact on C. difficile infection rates in tertiary hospital: A double edged sward. Am J Infect Control 2013;41:270-2. [CrossRef]
  • 17. Babady NE, Stiles J, Ruggiero P, Khosa P, Huang D, Shuptar S, et al. Evaluation of Cepheid Xpert C. difficile epi assay for diagnosis of C. difficile infection and typing of the NAP1 strain at a cancer hospital. J Clin Microbiol 2010;48:4519-24. [CrossRef]
  • 18. Lyerly DM, Ball DW, Toth J, Wilkins TD. Characterization of cross-reactive proteins detected by Culturette Brand Rapid Latex Test for Clostridium difficile. J Clin Microbiol 1988;26:397- 400.
  • 19. Goldenberg SD, French GL. Diagnostic testing for C. difficile: a comprehensive survey of laboratories in England. J Hosp Infect 2011;79:4-7. [CrossRef]
  • 20. Surawicz CM. Clostridium difficile infection: risk factors, diagnosis and management. Curr Treat Options Gastroenterol 2015;13:121-9. [CrossRef]
  • 21. Korac M, Milosevic I, Markovic M, Popovic N, Ilic M, Markovic A, et al. Clostridium difficile infection: a Serbian single-center experience. J Infect Dev Ctries 2015;19;9:136-40. [CrossRef]
  • 22. Kilic A. Clostridium difficile Infection: Epidemiology, Risk Factors, Pathogenesis, Clinical Features, Diagnosis and Therapy. Mikrobiyol Bul 2013;47:556-66. [CrossRef]
  • 23. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:89-95. [CrossRef]
  • 24. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of real-time PCR for detection of the tcdC gene with four toxin immunoassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol 2008;46:1996-2001. [CrossRef]
  • 25. Juneau C, Mendias EN, Wagal N, Loeffelholz M, Savidge T, Croisant S, et al. Community-Acquired Clostridium Difficile Infection: Awareness and Clinical Implications. J Nurse Pract 2013;9:1-6. [CrossRef]
  • 26. Zheng, L, Keller SF, Lyerly DM, Carman RJ, Genheimer CW, et al. Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens. J Clin Microbiol 2004;42:3837-40. [CrossRef]
  • 27. Debast SB, Bauer MP, Kuijper EJ; European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20:1-26. [CrossRef]
  • 28. Krutova M, Matejkova J, Nyc OC. Difficile ribotype 027 or 176? Folia Microbiol (Praha) 2014;59:523-6. [CrossRef]

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

Year 2016, Volume: 33 Issue: 1, 80 - 86, 01.01.2016

Abstract

Background: Clostridium difficile is a common cause of hospital-acquired diarrhea, which is usually associated with previous antibiotic use. The clinical manifestations of C. difficile infection (CDI) may range from mild diarrhea to fulminant colitis. Clostridium difficile should be considered in diarrhea cases with a history of antibiotic use within the last 8 weeks (community-associated CDI) or with a hospital stay of at least 3 days, regardless of the duration of antibiotic use (hospital-acquired CDI). Aims: This study investigated the frequency of CDI in diarrheic patients and evaluated the efficacy of the triple diagnostic algorithm that is proposed here for C. difficile detection. Study Design: Cross-sectional study. Methods: In this study, we compared three methods currently employed for C. difficile detection using 95 patient stool samples: an enzyme immunoassay (EIA) for toxin A/B (C. diff Toxin A+B; Diagnostic Automation Inc.; Calabasas, CA, USA), an EIA for glutamate dehydrogenase (GDH) (C. DIFF CHEK-60TM, TechLab Inc.; Blacksburg, VA, USA), and a polymerase chain reaction (PCR)-based assay (GeneXpert® C. difficile; Cepheid, Sunnyvale, CA, USA) that detects C. difficile toxin genes and conventional methods as well. In this study, 50.5% of the patients were male, 50 patients were outpatients, 32 were from inpatient clinics and 13 patients were from the intensive care unit. Results: Of the 95 stool samples tested for GDH, 28 were positive. Six samples were positive by PCR, while nine samples were positive for toxin A/B. The hypervirulent strain NAP-1 and binary toxin was not detected. The rate of occurrence of toxigenic C. difficile was 5.1% in the samples. Cefaclor, ampicillin-sulbactam, ertapenem, and piperacillin-tazobactam were the most commonly used antibiotics by patients preceding the onset of diarrhea. Among the patients who were hospitalized in an intensive care unit for more than 7 days, 83.3% were positive for CDI by PCR screening. If the PCR test is accepted as the reference: C. difficile Toxin A/B ELISA sensitivity and specificity were 67% and 94%, respectively, and GDH sensitivity and specificity were 100% and 75%, respectively. Conclusion: Tests targeting C. difficile toxins are frequently applied for the purpose of diagnosing CDI in a clinical setting. However, changes in the temperature and reductant composition of the feces may affect toxin stability, potentially yielding false-negative test results. Therefore, employment of a GDH EIA, which has high sensitivity, as a screening test for the detection of toxigenic strains, may prevent false-negative results, and its adoption as part of a multistep diagnostic algorithm may increase accuracy in the diagnosis of CDIs.

References

  • 1. Thielman NM, Wilson KH: Antibiotic-associated colitis. In Principles and Practice of Infectious Diseases. 7th press. Benett (ed) Mandell GL, JE Dolin R. (eds), Churchill Livingstone, New York 2010. [CrossRef
  • 2. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015;313:398-408. [CrossRef]
  • 3. Rodriguez C, Korsak N, Taminiau B, Avesani V, Van Broeck J, Delmée M, et al. Clostridium difficile infection in elderly nursing home residents. Anaerobe 2014;30:184-7. [CrossRef]
  • 4. Tunçcan OG, Ulutan F, Karakuş R. The frequency of Clostridium difficile toxin in neutropenic and non-neutropenic patients with antibiotic-associated diarrhea and analysis of the risk factors. Mikrobiyol Bul 2008;42:573-83.
  • 5. Freeman J, Bauer MP, Baines SD, Corver J, Fawley WN, Goorhuis B, et al. The Changing Epidemiology of Clostridium difficile Infections. Clin Microbiol Rev 2010;529-49. [CrossRef]
  • 6. Crobach MJ, Dekkers OM, Wilcox MH, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect 2009;15:1053-66. [CrossRef]
  • 7. Merz CS, Kramer C, Forman M, Gluck L, Mills K, Senft K, et al. Comparison of four commercially available rapid enzyme immunassays with cytotoxin assay for detection of Clostridium difficile toxin(s) from stool specimens. J Clin Microbiol 1994;32:1142-7.
  • 8. Alcalá L, Sánchez-Cambronero L, Catalán MP, Sánchez-Somolinos M, Peláez MT, Marín M, et al. Comparison of three commercial methods for rapid detection of Clostridium difficile toxin A and B from fecal specimens. J Clin Microbiol 2008;46:3833-5. [CrossRef]
  • 9. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of real time PCR for detection of the tcdC gene with four toxin immunassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol 2008;46:1996-2001. [CrossRef]
  • 10. Altindis M, Usluer S, Ciftçi H, Tunç N, Cetinkaya Z, Aktepe OC. Investigation of the presence of Clostridium difficile in antibiotic associated diarrhea patients by culture and toxin detection methods. Mikrobiyol Bul 2007;41:29-37.
  • 11. Oldfield EC. Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment. Rev Gastroenterol Disord 2004;4:186-95.
  • 12. Zheng L, Keller SF, Lyerly DM, Carman RJ, Genheimer CW, Gleaves CA, et al. Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens. J Clin Microbiol 2004;42:3837-40. [CrossRef]
  • 13. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:5. [CrossRef]
  • 14. LaSala PR, Svensson AM, Mohammad AA, Perrotta PL. Comparison of Analytical and Clinical Performance of Three Methods for Detection of Clostridium difficile. Arch Pathol Lab Med 2012;136:527-31. [CrossRef]
  • 15. Fenner L, Widmer AF, Goy G, Rudin S, Frei R. Rapid and reliable diagnostic algorithm for detection of Clostridium difficile. J Clin Microbiol 2008;46:328-30. [CrossRef]
  • 16. Williamson DA, Basu I, Freeman J, Swager T, Roberts SA. Improved detection of toxigenic C. difficile using the Cepheid Xpert C. difficile assay and impact on C. difficile infection rates in tertiary hospital: A double edged sward. Am J Infect Control 2013;41:270-2. [CrossRef]
  • 17. Babady NE, Stiles J, Ruggiero P, Khosa P, Huang D, Shuptar S, et al. Evaluation of Cepheid Xpert C. difficile epi assay for diagnosis of C. difficile infection and typing of the NAP1 strain at a cancer hospital. J Clin Microbiol 2010;48:4519-24. [CrossRef]
  • 18. Lyerly DM, Ball DW, Toth J, Wilkins TD. Characterization of cross-reactive proteins detected by Culturette Brand Rapid Latex Test for Clostridium difficile. J Clin Microbiol 1988;26:397- 400.
  • 19. Goldenberg SD, French GL. Diagnostic testing for C. difficile: a comprehensive survey of laboratories in England. J Hosp Infect 2011;79:4-7. [CrossRef]
  • 20. Surawicz CM. Clostridium difficile infection: risk factors, diagnosis and management. Curr Treat Options Gastroenterol 2015;13:121-9. [CrossRef]
  • 21. Korac M, Milosevic I, Markovic M, Popovic N, Ilic M, Markovic A, et al. Clostridium difficile infection: a Serbian single-center experience. J Infect Dev Ctries 2015;19;9:136-40. [CrossRef]
  • 22. Kilic A. Clostridium difficile Infection: Epidemiology, Risk Factors, Pathogenesis, Clinical Features, Diagnosis and Therapy. Mikrobiyol Bul 2013;47:556-66. [CrossRef]
  • 23. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:89-95. [CrossRef]
  • 24. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of real-time PCR for detection of the tcdC gene with four toxin immunoassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol 2008;46:1996-2001. [CrossRef]
  • 25. Juneau C, Mendias EN, Wagal N, Loeffelholz M, Savidge T, Croisant S, et al. Community-Acquired Clostridium Difficile Infection: Awareness and Clinical Implications. J Nurse Pract 2013;9:1-6. [CrossRef]
  • 26. Zheng, L, Keller SF, Lyerly DM, Carman RJ, Genheimer CW, et al. Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens. J Clin Microbiol 2004;42:3837-40. [CrossRef]
  • 27. Debast SB, Bauer MP, Kuijper EJ; European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20:1-26. [CrossRef]
  • 28. Krutova M, Matejkova J, Nyc OC. Difficile ribotype 027 or 176? Folia Microbiol (Praha) 2014;59:523-6. [CrossRef]
There are 28 citations in total.

Details

Other ID JA79KU72ER
Journal Section Research Article
Authors

Özlem Yoldaş This is me

Mustafa Altındiş This is me

Davut Cufalı This is me

Gülşah Aşık This is me

Recep Keşli This is me

Publication Date January 1, 2016
Published in Issue Year 2016 Volume: 33 Issue: 1

Cite

APA Yoldaş, Ö., Altındiş, M., Cufalı, D., Aşık, G., et al. (2016). A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea. Balkan Medical Journal, 33(1), 80-86.
AMA Yoldaş Ö, Altındiş M, Cufalı D, Aşık G, Keşli R. A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea. Balkan Medical Journal. January 2016;33(1):80-86.
Chicago Yoldaş, Özlem, Mustafa Altındiş, Davut Cufalı, Gülşah Aşık, and Recep Keşli. “A Diagnostic Algorithm for the Detection of Clostridium Difficile-Associated Diarrhea”. Balkan Medical Journal 33, no. 1 (January 2016): 80-86.
EndNote Yoldaş Ö, Altındiş M, Cufalı D, Aşık G, Keşli R (January 1, 2016) A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea. Balkan Medical Journal 33 1 80–86.
IEEE Ö. Yoldaş, M. Altındiş, D. Cufalı, G. Aşık, and R. Keşli, “A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea”, Balkan Medical Journal, vol. 33, no. 1, pp. 80–86, 2016.
ISNAD Yoldaş, Özlem et al. “A Diagnostic Algorithm for the Detection of Clostridium Difficile-Associated Diarrhea”. Balkan Medical Journal 33/1 (January 2016), 80-86.
JAMA Yoldaş Ö, Altındiş M, Cufalı D, Aşık G, Keşli R. A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea. Balkan Medical Journal. 2016;33:80–86.
MLA Yoldaş, Özlem et al. “A Diagnostic Algorithm for the Detection of Clostridium Difficile-Associated Diarrhea”. Balkan Medical Journal, vol. 33, no. 1, 2016, pp. 80-86.
Vancouver Yoldaş Ö, Altındiş M, Cufalı D, Aşık G, Keşli R. A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea. Balkan Medical Journal. 2016;33(1):80-6.