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Background  New molecular methods of detecting  Clostridium difficile  infection (CDI) provide the routine lab with a sensitive random access method to produce results that are available in a shorter time than traditional methods.    Methods  In this prospective study a total of 989 stool specimens were tested over a period of 16 months in parallel using two isothermal amplification assays, AmpliVue® (Quidel) and Illumigene® (Meridian) and the results compared to those from toxigenic culture. In addition all specimens were tested using a cytotoxic cell neutralisation assay (CCNA) and three different Real-time PCR targeting a  C. difficile -specific 16S rDNA sequence or the toxin genes  tcdA ,  tcdB/tcdB027  or  cdtB .    Results  AmpliVue® was positive in 242 (24.5 %) and Illumigene® in 228 (23.1 %) specimens. 167 (16.9 %) specimens were positive in toxigenic culture. Real-time- tcdA  and - tcdB  PCR was positive in 211 (21.3 %) specimens, Real-time -cdtB  PCR was positive in 101 (10.2 %) specimens and  C. difficile -PCR (16S rDNA) in 267 (27.0 %) specimens.    Conclusions  The respective sensitivity, specificity, positive predictive value and negative predictive value compared to toxigenic culture were 91, 89, 62 and 98 % for AmpliVue® and 91, 91, 67 and 98 % for Illumigene®.

bmc microbiology

A prospective study of two isothermal amplification assays compared with real-time PCR, CCNA and toxigenic culture for the diagnosis of Clostridium difficile infection