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Clostridium difficile infection diagnosis in a paediatric population: comparison of methodologies
J Hart1, P Putsathit, D R Knight
1Microbiology, PathWest Laboratory Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia, julie.hart@health.wa.gov.au.
Insights
Accurate diagnosis of Clostridium difficile infection (CDI) is vital in children. Molecular tests showed the best performance for detecting CDI in a high-prevalence pediatric hospital setting.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatric Healthcare
Background:
- Clostridium difficile infection (CDI) incidence is rising in hospitalized children.
- Emergence of hypervirulent strains and community-acquired CDI necessitates prompt diagnosis.
- Accurate and rapid diagnostic methods are crucial for effective treatment and infection control in pediatric populations.
Purpose of the Study:
- To validate commonly used Clostridium difficile diagnostic tests in a pediatric hospital setting.
- To compare the performance of various diagnostic methods, including immunoassays, culture, and molecular assays.
- To determine the optimal diagnostic strategy for CDI in a high-prevalence pediatric population.
Main Methods:
- Prospective validation of diagnostic tests on 150 stool samples from 75 pediatric patients.
- Tests included: C. Diff Quik Chek Complete (GDH and toxin), Illumigene, GeneOhm, cycloserine cefoxitin fructose agar (CCFA) culture, and cell culture cytotoxin neutralisation assay (CCNA).
- Reference standard involved CCFA or Cdiff Chromagar culture, PCR for toxin genes, and PCR ribotyping.
Main Results:
- High prevalence of CDI (43%) observed in the study population.
- Glutamate dehydrogenase (GDH) test showed a low negative predictive value (NPV).
- Cell culture cytotoxin neutralisation assay (CCNA) and Quik Chek Complete toxin assay had poor sensitivity. Molecular methods demonstrated 89% sensitivity, outperforming other tests and algorithms.
- Ribotype UK014/20 was predominant. GDH NPV and molecular sensitivities were lower than in adult studies.
Conclusions:
- Commonly used tests like Quik Chek Complete and CCNA are unreliable for detecting toxigenic CDI in children.
- GDH-based algorithms demonstrated reduced sensitivity in this pediatric cohort.
- Molecular methods alone are recommended for diagnosing CDI in high-prevalence pediatric populations due to superior performance characteristics.
Abstract:
The increasing incidence of Clostridium difficile infection (CDI) in paediatric hospitalised populations, combined with the emergence of hypervirulent strains, community-acquired CDI and the need for prompt treatment and infection control, makes the rapid, accurate diagnosis of CDI crucial. We validated commonly used C. difficile diagnostic tests in a paediatric hospital population. From October 2011 to January 2012, 150 consecutive stools were collected from 75 patients at a tertiary paediatric hospital in Perth, Western Australia. Stools were tested using: C. Diff Quik Chek Complete, Illumigene C. difficile, GeneOhm Cdiff, cycloserine cefoxitin fructose agar (CCFA) culture, and cell culture cytotoxin neutralisation assay (CCNA). The reference standard was growth on CCFA or Cdiff Chromagar and PCR on isolates to detect tcdA, tcdB, cdtA, and cdtB. Isolates were PCR ribotyped. The prevalence of CDI was high (43 % of patients). Quik Chek Complete glutamate dehydrogenase (GDH) demonstrated a low negative predictive value (NPV) (93 %). Both CCNA and Quik Chek Complete toxin A/B had poor sensitivity (33 % and 29 % respectively). Molecular methods both had 89 % sensitivity. Algorithms using GDH + Illumigene or GeneOhm reduced the sensitivity to 85 % and 83 % respectively. Ribotype UK014/20 predominated. GDH NPV and GeneOhm and Illumigene sensitivities were reduced compared with adult studies. Quik Chek Complete and CCNA cannot reliably detect toxigenic CDI. A GDH first algorithm showed reduced sensitivity. In a high prevalence paediatric population, molecular methods alone are recommended over the use of GDH algorithm or culture and CCNA, as they demonstrate the best test performance characteristics.
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