A European survey of diagnostic methods and testing protocols for Clostridium difficile

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age .60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values , 0 . 05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

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“…This study showed major discrepancies between laboratories and between countries (Barbut et al, 2003).…”

Section: Introductionmentioning

confidence: 66%

“…Mostly C. difficile toxin EIAs are used for the diagnosis of CDAD (Barbut et al, 2003). Stool culture is used in 20 % (Great Britain) to 100 % (Denmark) of laboratories.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Ackermann

Thomalla

Ackermann

et al. 2005

Journal of Medical Microbiology

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“…The recent European survey of diagnostic methods and testing protocols by Barbut et al (2003) clearly shows the wide variations of protocols observed among laboratories from different countries. Although most countries, except Denmark, routinely perform toxin detection on stools, the figure is quite different for culture: more than 90 % of the laboratories in Denmark and Belgium perform it but only 28 % in Spain and 20 % in the UK.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the recommendations issued in the USA and UK limit the diagnosis to a single toxindetection test on faecal specimens by cultured cells or IA, although in several other European countries both culture and toxin detection are recommended for an optimal diagnosis (Berrington et al, 2004;Bartlett, 2002;Brazier, 1998;Delmée, 2001). A recent survey has clearly shown the large variations in the methods used when comparing laboratories from different European countries (Barbut et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Delmée

Broeck

Simon

et al. 2005

Journal of Medical Microbiology

147

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A routine protocol for diagnosing Clostridium difficile-associated diarrhoea (CDAD) based on both faecal-cytotoxin detection and toxigenic culture was adopted by the microbiology laboratory of the St Luc-UCL University Hospital in Brussels in 1997. A toxigenic culture is a faecal culture followed, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production. The results obtained over the past 7 years in the hospital are reviewed here. A total of 10 552 diarrhoeal stools from 7042 patients were analysed, of which 9494 were negative for all tests. A total of 1058 samples (10 %) from 794 patients were culture-positive, of which 460 (4 . 4 %) were positive for a faecal cytotoxin. The remaining 598 cultures were tested for toxin A on colonies; 355 of them were positive, which is 3 . 4 % of the total, and the remaining 243 (2 . 3 %) were negative. The positivity of the faecalcytotoxin assay was statistically linked to the number of colonies observed on the culture plate. In conclusion, over a 7 year period, toxigenic culture allowed the diagnosis of 355 cases of CDAD that would have been missed by a protocol using a faecal-cytotoxin assay alone. In terms of both patient care, prevention of environmental contamination and prevention of risk of a hospital outbreak, it is proposed that these results justify the recommendation to perform both faecal-toxin assay and culture in routine medical practice.

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“…Toxin enzyme immunoassays are more rapid and easier to perform but are suboptimal if used as stand-alone assays due to the low sensitivity compared to CCNA or toxigenic C. difficile culture (3,7,10). Today, many laboratories rely on C. difficile toxin A/B testing alone despite the limits of this approach and have abandoned bacterial culture (2,3). Detection of the C. difficile-specific enzyme glutamate dehydrogenase antigen (GDH) may in part replace culture techniques and therefore be an alternative to culture (9,10,12,13).…”

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confidence: 99%

Rapid and Reliable Diagnostic Algorithm for Detection of Clostridium difficile

et al. 2008

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We evaluated a two-step algorithm for detection of Clostridium difficile in 1,468 stool specimens. First, specimens were screened by an immunoassay for C. difficile glutamate dehydrogenase antigen (C.DIFF CHEK-60). Second, screen-positive specimens underwent toxin testing by a rapid toxin A/B assay (TOX A/B QUIK CHEK); toxin-negative specimens were subjected to stool culture. This algorithm allowed final results for 92% of specimens with a turnaround time of 4 h.

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A European survey of diagnostic methods and testing protocols for Clostridium difficile

Cited by 106 publications

References 36 publications

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Rapid and Reliable Diagnostic Algorithm for Detection of Clostridium difficile

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