Rapid-Tests Detection Evaluation of <i>Clostridium difficile </i>Toxins and Microbiological Investigation

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  • NAKAGAWA Risa
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • IINUMA Yoshitsugu
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • YAMAMOTO Masaki
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • MATSUMURA Yasufumi
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • SHIRANO Michinori
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • MATSUSHIMA Aki
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • NAGAO Miki
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • SAITO Takashi
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • TAKAKURA Shunji
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • ITO Yutaka
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • HIGUCHI Takeshi
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • TANAKA Michio
    Department of Clinical Laboratory Medicine, Kyoto University Hospital
  • ICHIYAMA Satoshi
    Department of Infection Control & Prevention, Kyoto University Hospital Department of Clinical Laboratory Medicine, Kyoto University Hospital

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Other Title
  • <i>Clostridium difficile </i>トキシン迅速検査キットの評価と 微生物学的検討
  • Clostridium difficileトキシン迅速検査キットの評価と微生物学的検討
  • Clostridium difficile トキシン ジンソク ケンサ キット ノ ヒョウカ ト ビセイブツガクテキ ケントウ

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Abstract

We evaluated two rapid toxin tests for C. difficile combined with stool specimen cultures used from January 2006 to March 2009. Stool specimens numbered 877, 102 among which were from the cases of diagnosed clinical C. difficile-associated diarrhea (CDAD). Rapid toxin A ʻUniquickʼdetection kits were used until October 2007 and toxin A&B ʻTOX A/Bʼdetection kits thereafter. Clinical CDAD was considered the detection gold standard. Uniquick sensitivity, specificity, and positive and negative predictive values were 54.3％, 99.1％, 90.5％, and 93.2％ while those for TOX A/B were 46.2％, 97.6％, 65.2％, and 95.0％ and for culture 42.2％, 95.5％, 55.1％, and 92.6％. Rapid toxin tests tended to have better sensitivity than culture results although not significantly so, and Uniquick showed significantly better positive predictive value than TOX A/B or culture results. Among clinical CDAD cases, concordance with culture was 24.3％for Uniquick and 53.1％for TOX A/B. For stored strains, 27 were typed toxin A＋B＋(48.1％), toxin A－B＋(37.0％) and toxin A－B－(14.8％) with toxin gene detection by PCR. Eight of the 10 toxin A－B＋strains were classified into two cluster by ribotyping, and 7 of those were detected in two hospital wards, indicated the possibility of nosocomial toxin A－B＋strain spread. The rapid toxin test for both toxins A and B should be used if toxin A－B＋predominate. Simultaneous culture testing may be useful for detecting clinical CDAD more accurately, however.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 84 (2), 147-152, 2010

    The Japanese Association for Infectious Diseases

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