[New methodological advances: algorithm proposal for management of Clostridium difficile infection].

Area of Science:

• Microbiology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea.
• CDI also contributes to community-acquired diarrhea.
• Accurate and efficient diagnostic methods are crucial for managing CDI.

Purpose of the Study:

• To evaluate a diagnostic strategy using simultaneous glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B detection.
• To assess the utility of polymerase chain reaction (PCR) for the C. difficile toxin B (tcdB) gene as a confirmatory test for discordant results.
• To propose an improved diagnostic algorithm for CDI.

Main Methods:

• Stool samples were tested for simultaneous GDH and toxin A/B detection, and toxin A/B alone.
• Samples with discordant GDH and toxin A/B results underwent PCR for the tcdB gene.
• A total of 116 samples from 52 patients were analyzed.

Main Results:

• The combined GDH and toxin A/B test identified 79 cases of toxigenic C. difficile.
• An additional 7 cases were identified by PCR for the tcdB gene among samples negative for toxin A/B.
• The proposed algorithm successfully recovered previously undiagnosed CDI cases.

Conclusions:

• Simultaneous GDH and toxin A/B testing, coupled with PCR for the tcdB gene, enhances CDI diagnosis.
• A proposed two-step algorithm involves GDH detection followed by PCR for positive samples.
• This algorithm offers a potentially superior cost-benefit ratio for CDI diagnosis in the studied population.