Open AccessLaboratory diagnosis of Clostridium difficile infection: Comparison of Techlab C. diff Quik Chek Complete, Xpert C. difficile, and multistep algorithmic approach
Author(s) -
Seo Ja Young,
Jeong Ji Hun,
Kim Kyung Hee,
Ahn JeongYeal,
Park PilWhan,
Seo YielHea
Publication year - 2017
Publication title -
journal of clinical laboratory analysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.536
H-Index - 50
eISSN - 1098-2825
pISSN - 0887-8013
DOI - 10.1002/jcla.22135
Subject(s) - clostridium difficile , medicine , c difficile , glutamate dehydrogenase , microbiology and biotechnology , clostridioides , predictive value , clinical microbiology , virology , biology , antibiotics , glutamate receptor , receptor
Background Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. We explored optimal laboratory strategies for diagnosis of C. difficile infection ( CDI ) in our clinical settings, a 1400‐bed tertiary care hospital. Methods Using 191 fresh stool samples from adult patients, we evaluated the performance of Xpert C. difficile (Xpert CD ), C. diff Quik Chek Complete (which simultaneously detects glutamate dehydrogenase [ GDH ] and C. difficile toxins [ CDT ]), toxigenic culture, and a two‐step algorithm composed of GDH / CDT as a screening test and Xpert CD as a confirmatory test. Results Clostridium difficile was detected in 35 samples (18.3%), and all isolates were toxigenic strains. The sensitivity, specificity, positive predictive value ( PPV ), and negative predictive value of each assay for detecting CDI were as follows: Quik Chek Complete CDT (45.7%, 100%, 100%, 89.1%), Quik Chek Complete GDH (97.1%, 99.4%, 97.1%, 99.4%), Xpert CD (94.3%, 100%, 100%, 98.7%), and toxigenic culture (91.4%, 100%, 100%, 98.1%). A two‐step algorithm performed identically with Xpert CD assay. Conclusion Our data showed that most C. difficile isolates from adult patients were toxigenic. We demonstrated that a two‐step algorithm based on GDH / CDT assay followed by Xpert CD assay as a confirmatory test was rapid, reliable, and cost effective for diagnosis of CDI in an adult patient setting with high prevalence of toxigenic C. difficile .