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Diagnosis and outcome of Clostridium difficile infection by toxin enzyme immunoassay and polymerase chain reaction in an island population.

Kumar, S; Pollok, R; Muscat, I; Planche, T (2017) Diagnosis and outcome of Clostridium difficile infection by toxin enzyme immunoassay and polymerase chain reaction in an island population. J Gastroenterol Hepatol, 32 (2). pp. 415-419. ISSN 1440-1746 https://doi.org/10.1111/jgh.13504
SGUL Authors: Planche, Timothy David

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Abstract

BACKGROUND AND AIM: Clostridium difficile infection (CDI) is a potentially life-threatening cause of diarrhea. Correct laboratory diagnosis is essential to differentiate CDI from other causes of diarrhea. A positive fecal C. difficile toxin (CDT) is the best indicator of CDI, but the significance of a positive fecal nucleic acid amplification test (NAAT) remains unclear. Our aim was to elucidate the significance of CDI diagnostics in patients in Jersey. METHODS: A retrospective, 5-year study was conducted at an island district general hospital of patients who developed CDI. Patients were grouped according to CDT and NAAT status and their association with outcome (indicators of severity and 30-day case-fatality rate) compared. RESULTS: A total of 207 specimens were toxin positive, 92 NAAT positive and toxin negative, and 39 had a stool sample negative by both toxin and NAAT testing. A positive toxin stool sample was associated with both significantly higher white cell count (14.5 × 10(9) /L vs 11.3 × 10(9) /L, P = 0.003) and C-reactive protein (114.7 mg/dL vs 82.9 mg/dL, P = 0.001), but NAAT positivity was not (P = 0.269, 0.728). A positive CDT assay was a significant independent predictor of death (odds ratio [OR]: 1.89 [95% CI: 1.04-3.43], P = 0.046), but a positive NAAT in CDT negative samples was not (OR: 1.02 [95% CI: 0.34-3.12], P = 1.0). CONCLUSIONS: The findings of this study, derived from evolving clinical practice, provide greater clarity in the interpretation of CDI diagnostics. In CDT-negative disease, a positive NAAT neither predicts disease severity nor mortality. NAAT-positive and toxin-negative patients require instigation of infection control measures, but the need for specific treatment remains unclear.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Kumar, S., Pollok, R., Muscat, I., and Planche, T. (2017) Diagnosis and outcome of Clostridium difficile infection by toxin enzyme immunoassay and polymerase chain reaction in an island population. Journal of Gastroenterology and Hepatology, 32: 415–419., which has been published in final form at http://dx.doi.org/10.1111/jgh.13504. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: Clostridium difficile, NAAT, PCR, toxin EIA, Clostridium difficile, NAAT, PCR, toxin EIA, Gastroenterology & Hepatology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: J Gastroenterol Hepatol
ISSN: 1440-1746
Language: eng
Dates:
DateEvent
21 February 2017Published
9 August 2016Published Online
26 July 2016Accepted
Publisher License: Publisher's own licence
PubMed ID: 27505006
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/108744
Publisher's version: https://doi.org/10.1111/jgh.13504

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