Abstract
Background:Clostridioides difficileInfection (CDI) is an acute disease that needs a fast proper treatment. Unfortunately, the diagnosis, and above all the understanding of the results, remain arduous.Objective:This study analyzed routine and integrative results of all fecal samples from patients over time. Our aim was to understand the dynamics of CDI infection and the meaning of “difficult to interpret” results, to make physicians better understand the various tools they can use.Methods:We evaluated routine results obtained from 815 diarrheal stools with Enzyme Immunoassay (EIA) that detectsC. difficileGlutamate Dehydrogenase (GDH) antigen and toxin B. We also reanalyzed a part of samples using integrative tests: a Real-time polymerase chain reaction (RT-PCR) forC. difficiletoxin B gene (tcdB) and the automated immunoassay VIDASC. difficilesystem for GDH and toxins A/B.Results:EIA GDH positivity increased through multiple testing over time, with aPvalue <0.001, depicting a sort of bacterial growth curve. Eighty-five percent of GDH positive/toxin B negative,i.e., discrepant, samples PCR weretcdBpositive, 61.5% of discrepanttcdBpositive samples were VIDAS toxins A/B positive, and 44.4% of GDH EIA negative stools were VIDAS GDH positive.Conclusion:The results confirmed the low sensitivity of the EIA system forC. difficileGDH and toxins, questioned the use of the latter for concluding any CDI diagnostic algorithm, and led us to indicate the algorithm beginning with tcdB molecular research, and continuing in positive cases with VIDAS CD GDH method, as the most effective for CDI.
Highlights
Clostridioides difficile is a Gram-positive, spore forming, strictly anaerobic bacterium
We evaluated routine results obtained from 815 diarrheal stools with Enzyme Immunoassay (EIA) that detects C. difficile Glutamate Dehydrogenase (GDH) antigen and toxin B
The results confirmed the low sensitivity of the EIA system for C. difficile GDH and toxins, questioned the use of the latter for concluding any Clostridioides difficile Infection (CDI) diagnostic algorithm, and led us to indicate the algorithm beginning with tcdB molecular research, and continuing in positive cases with VIDAS CD GDH method, as the most effective for CDI
Summary
Clostridioides difficile is a Gram-positive, spore forming, strictly anaerobic bacterium. It is the leading cause of the principal antibiotic-associated diarrhea. C. difficile Infection (CDI) is mediated by cytotoxic enzymes, i.e., toxin A (TcdA), toxin B (TcdB), and, when present, by the binary toxin (CDT), which can potentiate intestinal damage [1]. Given the feature of acute infection, CDI needs a rapid reliable diagnosis, which avoids empirical therapies and consequent further dismicrobism, responsible for most cases [2]. The Cell Cytotoxicity Neutralization Assay (CCNA) primarily reveals the presence of TcdB through cytopathic effect, whose specificity is assured precisely by neutralization. Clostridioides difficile Infection (CDI) is an acute disease that needs a fast proper treatment. The diagnosis, and above all the understanding of the results, remain arduous
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