A bedside test for Clostridium Difficile infection: an Emergency Department use. Preliminary results

Clostridium Difficile (CD) infection is a severe cause of diarrhea in patients with prolonged hospitalization and/or previously treated with antibiotics. CD's A and B toxins are responsible for either diarrhea or septical status as well as other complications including toxic megacolon. Toxins isolation, usually performed by a central microbiological laboratory (CML), is mandatory for the final diagnosis of the disease. The clinical suspect of CD infection (CDI) results in the isolation of the patients, until the fecal test does not exclude the disease. Positive patients need to maintain isolation and start a specific antibiotic therapy. The aim of this study was to verify the sensitivity and specificity of a rapid test for the diagnosis of CDI.

We enrolled 20 (13F/7M, mean age 70 ± 12 yrs) consecutive pts who accessed the Emergency Department (ED) with diarrhea and a clinical suspect of CDI. An immune-enzymatic bedside test (Beta Dignostici, Messina, Italy) for the detection of GDH, toxin A and B of CD was used. The results of this test were then compared to the CML one's, on the same patient.

6 patients resulted positive to the bedside test compared to 7 of CML test (86% of concordance). In this patient, the bedside test showed a strong positivity for GDH without signs of toxin, meanwhile the CML test revealed the toxins. Possibly, the lower toxins concentration in this patient was responsible for such discordance. Both tests showed a full concordance for negative patients. Another interesting finding is that the bedside test provides results in only 5 minutes, compared to several hours (even 48) of CML test.

The bedside test is a rapid and affordable tool for rapid diagnosis of CD infection especially in a ED where the positivity of the test affects either hospitalization or treatment.