European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection

Crobach, Monique J. T.; Planche, Tim; Eckert, Catherine; Barbut, Frédéric; Terveer, Elisabeth M.; Dekkers, Olaf M.; Wilcox, Mark H.; Kuijper, Ed J.

doi:10.1016/j.cmi.2016.03.010

Cited by 495 publications

(559 citation statements)

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“…The contamination route can be explained by the manual handling of the tubes containing the isolated DNA and PCR mixture to the Rotor-Gene, which required placing caps on tiny tubes, arranged very close to each other. The sensitivity of both PCRs and specificity of the in-house PCR are in agreement with the NAAT performance in symptomatic C. difficile patients, as mentioned in the recently published European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidance document, with an overall sensitivity of 95% and specificity of 98% in comparison with TC (20). A discrepancy analysis was performed, mainly to clarify why conflicting test results were obtained.…”

Section: Discussionmentioning

confidence: 70%

“…Guerrero et al showed that asymptomatic carriers have lower numbers of C. difficile in their rectal swab than CDI patients, indicating that stool samples should be preferred (4). Furthermore, a mix of diagnostic screening tests have been applied to detect C. difficile, frequently subdivided into assays to recognize toxigenic or nontoxigenic strains (20). However, a comparison of various diagnostic tests with a reference method to detect asymptomatic colonization of C. difficile has not been studied before.…”

Section: Discussionmentioning

confidence: 99%

“…A recently published European guidance document advises a two-stage algorithm to diagnose CDI using a toxin nucleic acid amplification test (NAAT) or glutamate dehydrogenase (GDH) enzyme immunoassay (EIA) as sensitive screening assay in combination with tests to detect the presence of free toxins in stools as a marker of disease activity (20). Samples without free toxins detected will largely represent asymptomatic carriers.…”

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confidence: 99%

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Detection of Clostridium difficile in Feces of Asymptomatic Patients Admitted to the Hospital

et al. 2017

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Recent evidence shows that patients asymptomatically colonized with Clostridium difficile may contribute to the transmission of C. difficile in health care facilities. Additionally, these patients may have a higher risk of developing C. difficile infection. The aim of this study was to compare a commercially available PCR directed to both toxin A and B (artus C. difficile QS-RGQ kit CE; Qiagen), an enzymelinked fluorescent assay to glutamate dehydrogenase (GDH ELFA) (Vidas, bioMéri-eux), and an in-house-developed PCR to tcdB, with (toxigenic) culture of C. difficile as the gold standard to detect asymptomatic colonization. Test performances were evaluated in a collection of 765 stool samples obtained from asymptomatic patients at admission to the hospital. The C. difficile prevalence in this collection was 5.1%, and 3.1% contained toxigenic C. difficile. Compared to C. difficile culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C. difficile GDH ELFA were 87.2%, 91.2%, 34.7%, and 99.3%, respectively. Compared with results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of the commercially available PCR and the in-house PCR were 95.8%, 93.4%, 31.9%, 99.9%, and 87.5%, 98.8%, 70%, and 99.6%, respectively. We conclude that in a lowprevalence setting of asymptomatically colonized patients, both GDH ELFA and a nucleic acid amplification test can be applied as a first screening test, as they both display a high NPV. However, the low PPV of the tests hinders the use of these assays as stand-alone tests.KEYWORDS Clostridium difficile, asymptomatic, carrier, diagnostics C lostridium difficile infection (CDI) is a leading cause of hospital-acquired diarrhea. The transmission of spores from symptomatic patients can spread C. difficile within health care facilities, with a subsequent development of more symptomatic patients and eventually clusters and outbreaks. However, recent data suggest that patients asymptomatically colonized with C. difficile also contribute to the spread of C. difficile spores to the environment and to other patients (1-3). Asymptomatic carriers shed spores into the environment to a lesser extent than CDI patients (3, 4), but by outnumbering the CDI patients, they can still play an important role in the transmission of the disease. This hypothesis has recently been supported in a Canadian study, where isolation of C. difficile-colonized patients significantly reduced the incidence of hospitalacquired CDI (5). A second new insight into the significance of asymptomatic colonization is that it may increase the risk of subsequent clinical disease in some colonized patients (6-10). Progression from colonization to CDI can be provoked by alterations of the microbiota and a subsequent decrease in secondary bile acids, which normally inhibit spore germination (11-13). But other factors, like preexisting antitoxin antibod-

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Detection of Clostridium difficile in Feces of Asymptomatic Patients Admitted to the Hospital

et al. 2017

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“…So far there, are several reviews of the molecular methods developed to detect C. difficile toxins, and their use for diagnosis [100,107,110,111,[113][114][115]. In the last two years, some immunoassays have been developed [116][117][118][119] that can overcome the stagnation of C. difficile toxin detection.…”

Section: Difficile Toxinsmentioning

confidence: 99%

Rapid Tests for Detection of Main Clostridial Toxins

Pérez-Etcheverry

Carmen

2017

IRA-JAS

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“…C. difficile polymerase chain reaction (PCR) is a highly sensitive test, though it does not distinguish colonization from active infection with a toxigenic strain, problematic if PCR is the sole means of diagnosis. Their center utilizes a two-step assay, which has been recommended in recently published clinical guidelines [14], with the enzyme immunoassay for toxins A and B enhancing specificity. Rates of C difficile colonization at the time of hospital admission are as high as 10% [15] possibly much higher in patients with IBD [16].…”

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confidence: 99%