[Experience with laboratory diagnosis of Clostridium difficile]

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Diagnostics

Background:

• Clostridium difficile infections (CDIs) are a significant cause of hospital-acquired diarrhea, with increasing community-associated cases.
• Pardubice Regional Hospital (PRH) observed a notable rise in CDI cases starting in 2010.
• This study aimed to evaluate laboratory diagnostic methods and the algorithm for CDI at PRH.

Purpose of the Study:

• To describe and evaluate laboratory diagnostic methods for Clostridium difficile infections (CDIs).
• To outline the diagnostic algorithm implemented for CDI detection at Pardubice Regional Hospital (PRH).

Main Methods:

• Stool samples from symptomatic patients were analyzed between July 2010 and December 2012.
• A dual enzyme immunoassay (D-EIA) detected glutamate dehydrogenase (GDH) and toxin A/B.
• GeneXpert PCR confirmed positive D-EIA findings, with all GDH-positive samples cultured since early 2011.

Main Results:

• Out of 2,040 samples, D-EIA tested 2,014, detecting both GDH and toxin A/B in 17.8% of cases.
• D-EIA sensitivity was 21.8% and specificity 97.2% for toxigenic strains.
• PCR confirmed 82 out of 140 examined samples, with toxin B gene detected in 47% and ribotype 027 markers in 48%.

Conclusions:

• The D-EIA test alone has low sensitivity for detecting toxigenic Clostridium difficile.
• A two-step algorithm (D-EIA followed by PCR) was implemented to enhance CDI diagnosis accuracy.
• This improved diagnostic approach allows for prompt isolation and appropriate antibiotic therapy for CDI patients.