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儿童感染:最佳的实验室诊断方法是什么?

Mohammed Suleiman¹, Patrick Tang^1,2, Omar Imam³

¹Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar.

|September 28, 2024

概括

在儿童中诊断Clostridioides difficile感染 (CDI) 是一个挑战. 使用PCR或胃肠道面板,然后进行毒素免疫检测的算法为儿科CDI诊断提供了最佳的性能.

科学领域:

儿童传染病儿童传染病
临床微生物学临床微生物学
诊断测试评价诊断测试评价

背景情况:

由于高无症状殖民率,儿童中Clostridioides difficile感染 (CDI) 的诊断是复杂的.
对于儿科CDI的最佳实验室诊断策略仍在争论中.
评估商业诊断测试对于准确的儿科CDI检测至关重要.

研究的目的:

为了比较各种商业诊断测试和算法在儿童群体中检测Clostridioides difficile感染 (CDI) 的性能.
确定最有效的测试策略来诊断0-18岁儿童的CDI.
根据周转时间,成本和临床效用来评估诊断性能.

主要方法:

374个儿科便样本 (2023年6月至12月) 用Techlab C. diffQuik Chek Complete,Cepheid GeneXpert C. difficile,QIAstat-Dx胃肠道面板和CHROMagar C. difficile培养物进行了测试.
独立测试和四个不同的测试算法与复合参考标准进行了评估.
绩效指标包括灵敏度,特异性,正预测值和负预测值.

主要成果:

在儿童CDI的不同诊断试验中观察到显著的性能变化.
结合Cepheid GeneXpert PCR或QIAstat-Dx面板作为初始查的算法,其次是Techlab C. diff Quik Chek完整毒素免疫测试以获得积极结果,证明了最佳性能.
这种优化的算法在与临床评估相结合时实现了100%的特异性和100%的积极预测值.

结论:

诊断方法的选择显著影响了儿童Clostridioides difficile感染 (CDI) 诊断的准确性.
建议使用多步算法,包括分子查和毒素检测,以及临床评估,用于儿科CDI诊断.
这种方法提高了诊断信心,并优化了儿科环境中的资源利用.

关键词:

克洛斯特里迪奥伊德斯困难菌孩子们的孩子们的孩子们的孩子们.诊断方法诊断方法儿科儿科儿科

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