Evaluation of different algorithm schemes in the laboratory diagnosis of Clostridioides difficile
Abstract
Purpose: Clostridioides difficile infection is a major cause of antibiotic-associated diarrhea, particularly in healthcare settings. This study aims to evaluate the applicability, speed, cost-effectiveness, and diagnostic accuracy of different laboratory algorithm schemes for C. difficile infection in a routine clinical setting.
Materials and Methods: A total of 479 stool samples from patients suspected of having C. difficile infection were analyzed using glutamate dehydrogenase enzyme immunoassay, toxin A/B enzyme immunoassay, toxigenic culture, and real-time polymerase chain reaction. The sensitivity, cost-effectiveness and overall diagnostic accuracy of these methods were assessed when applied in different algorithmic sequences.
Results: Of the 479 samples, 52 were positive for glutamate dehydrogenase antigen. Polymerase chain reaction exhibited the highest sensitivity, detecting
C. difficile in 55.8% of glutamate dehydrogenase -positive samples, followed by toxigenic culture at 25.0%, and toxin A/B enzyme immunoassay at 23.1%. The combination of glutamate dehydrogenase screening followed by polymerase chain reaction was the most effective diagnostic approach, offering both high sensitivity and cost-effectiveness.
Conclusion: The study emphasizes the importance of a multi-step diagnostic algorithm, particularly starting with glutamate dehydrogenase screening followed by PCR, to improve the accuracy and cost-effectiveness of C. difficile infection diagnosis. These findings support the need for tailored diagnostic strategies based on laboratory resources and patient population characteristics.
Keywords
diagnostic algorithm, toxigenic culture, enzyme immunoassay, glutamate dehydrogenase screening, Clostridioides difficile, PCR
Supporting Institution
This study was supported by the Istanbul University Scientific Research Projects Coordination Unit (Project No: 29794).
Project Number
This study was supported by the Istanbul University Scientific Research Projects Coordination Unit (Project No: 29794).
Ethical Statement
Ethical Approval: This study was approved by the Ethics Committee of Istanbul University, Istanbul Faculty of Medicine (Approval No: [1651/20.11.2012]).
Thanks
This study was supported by the Istanbul University Scientific Research Projects Coordination Unit (Project No: 29794).
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