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Impact of simultaneous glutamate dehydrogenase and toxin A/B rapid immunoassay on Clostridium difficile diagnosis and treatment in hospitalized patients with antibiotic‐associated diarrhea in a university hospital of Brazil
Author(s) -
Cançado Guilherme Grossi Lopes,
Silva Rodrigo Otávio Silveira,
Nader Amanda Pontes,
Lobato Francisco Carlos Faria,
Vilela Eduardo Garcia
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13901
Subject(s) - medicine , glutamate dehydrogenase , immunoassay , clostridium difficile , diarrhea , antibiotics , toxin , concordance , clostridium difficile toxin a , feces , gastroenterology , microbiology and biotechnology , immunology , antibody , glutamate receptor , biology , receptor
Background and Aim Clostridium difficile is a major cause of health care‐associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision‐making. Conventional enzyme immunoassay (EIA) for toxin detection is currently the most frequently used technique for C. difficile infection (CDI) diagnosis, but its low sensitivity makes the development of an alternative strategy necessary for improving the diagnosis in developing countries. Methods Between years 2011 and 2015, 154 stool samples from patients with antibiotic‐associated diarrhea were examined by toxigenic culture and EIA for the diagnosis of CDI. In the year 2015, when glutamate dehydrogenase (GDH) test was first available in Brazil, 53 of those fecal specimens were also tested by the C. diff Quik Chek Complete rapid immunoassay. At this time, we prospectively assessed the impact of this test on CDI treatment rates before and after it was introduced in clinical practice. Results The GDH component of C. diff Quik Chek Complete test had a sensitivity of 100% and specificity of 95.1% compared with toxigenic culture, with 89.8% concordance. The Tox A/B II EIA and the toxin portion of C. diff Quik Chek Complete yielded sensitivities between values of 50–58.3%, with 100% specificities. The introduction of GDH test increased the number of treated patients with CDI from 57.7% to 100%. Conclusions Glutamate dehydrogenase test is a reliable method for the diagnosis of CDI and greatly increases the number of properly treated patients with CDI. Therefore, this exam should be considered the mainstay for the laboratory diagnosis of CDI in developing countries.