Clostridioides difficile’nin laboratuvar tanısında farklı algoritma şemalarının değerlendirilmesi

Year 2024, Volume: 49 Issue: 3, 801 - 806, 30.09.2024

Gülay Trak , Cihan Yeşiloğlu , Betigül Öngen

https://doi.org/10.17826/cumj.1531627

Abstract

Amaç: Clostridioides difficile enfeksiyonu, başlıca hastanelerde olmak üzere, antibiyotiğe bağlı ishalin önemli bir nedenidir. Bu çalışmanın amacı, C. difficile enfeksiyonu için rutin klinik pratikte farklı laboratuvar algoritma şemalarının uygulanabilirliğini, hızını, maliyet etkinliğini ve tanısal doğruluğunu değerlendirmektir.
Gereç ve Yöntem: C. difficile enfeksiyonu şüphesi olan hastalardan alınan toplam 479 dışkı örneği, glutamat dehidrogenaz enzim immunoassay, toksin A/B immunoassay, toksijenik kültür ve gerçek zamanlı polimeraz zincir reaksiyonu kullanılarak incelenmiştir. Bu yöntemlerin farklı algoritmik dizilimlerde uygulandığında duyarlılıkları, maliyet etkinlikleri ve tanısal doğrulukları değerlendirilmiştir.
Bulgular: 479 örnekten 52'sinde glutamat dehidrogenaz antijeni pozitif bulunmuştur. Polimeraz zincir reaksiyonu, glutamat dehidrogenaz pozitif örneklerin %55,8'inde
C. difficile saptayarak en yüksek duyarlılığı göstermiştir; bunu %25 ile toksijenik kültür ve %23,1 ile toksin A/B enzim immunoassay izlemiştir. Glutamat dehidrogenaz antijeni taraması ve ardından yapılan polimeraz zincir reaksiyonundan oluşan algoritma hem yüksek duyarlılık hem de maliyet etkinliği sunan en etkin tanısal yaklaşım olmuştur.
Sonuç: Bu çalışma, C. difficile enfeksiyonu tanısında, başta glutamat dehidrogenaz antijen taraması ile başlayan ve ardından polimeraz zincir reaksiyonu uygulanan olmak üzere çok aşamalı algoritmaların tanısal doğruluğu ve maliyet etkinliği artırmadaki önemini vurgulamaktadır. Bu bulgular, laboratuvar kaynakları ve hasta popülasyonunun özelliklerine dayalı olarak uyarlanaan tanı stratejilerin gerekliliğini desteklemektedir.

Keywords

Clostridioides difficile, tanı algoritması, glutamat dehidrogenaz taraması, PCR, toksijenik kültür, enzim immunassay

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]).

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).

Thanks

This study was supported by the Istanbul University Scientific Research Projects Coordination Unit (Project No: 29794).

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

Project Number

This study was supported by the Istanbul University Scientific Research Projects Coordination Unit (Project No: 29794).

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