Abstract
BackgroundFecal leukocyte test (FLT) is widely used to screen for invasive diarrheas including C. difficile associated diarrhea (CDAD), which account for more than 25 % of all antibiotic associated diarrhea.Method263 stool samples from patients with suspected CDAD were studied simultaneously for fecal leukocyte test (FLT) and Clostridium difficile toxin assay (CDTA). FLT was performed by the Giemsa technique and CDTA was performed by enzyme immuno assay (EIA).ResultsSensitivity, specificity, positive predictive value and negative predictive value of FLT as compared to CDTA were 30%, 74.9%, 13.2% and 89.3% respectively.ConclusionConsidering the poor sensitivity of FLT, and the comparable cost and time of obtaining a CDTA at our institution, we conclude that FLT is not a good screening test for CDAD. Possible reasons for FLT being a poor predictor of CDTA are discussed.
Highlights
Willmore and Shearman[1] first described the fecal leukocyte stain in 1918 followed by its clinical use for diagnosis of bacterial diarrhea in 1972 by Harris et al [2]
We evaluated Fecal leukocyte test (FLT) within an inpatient cohort, defining the test's sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with C. difficile associated diarrhea (CDAD)
The PPV and NPV of FLT was 13.2 % and 89.3 % respectively for Clostridium difficile toxin assay (CDTA). 70% of all stool specimens positive for CDTA had a negative FLT
Summary
Willmore and Shearman[1] first described the fecal leukocyte stain in 1918 followed by its clinical use for diagnosis of bacterial diarrhea in 1972 by Harris et al [2]. Today fecal leukocyte testing (FLT) is widely used to screen for inflammatory diarrhea including C. difficile diarrhea, which account for more than 25 % of all antibiotic associated diarrhea. Laboratory diagnosis of C. difficile associated diarrhea (CDAD) is based on the detection of C. difficile toxins in stool samples by a cell culture cytotoxicity assay or enzyme immunoassay. We evaluated FLT within an inpatient cohort, defining the test's sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with CDAD. Fecal leukocyte test (FLT) is widely used to screen for invasive diarrheas including C. difficile associated diarrhea (CDAD), which account for more than 25 % of all antibiotic associated diarrhea
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