Comparison of two immunoassays for the detection of <i>Clostridium difficile</i> toxins and glutamate dehydrogenase in stool specimens

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  • <i>Clostridium difficile</i> ToxinおよびGDH抗原同時検出試薬の検出性能に関する比較検討

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<p>Clostridium difficile, a well-known nosocomial pathogen, is the major cause of antibiotic-associated diarrhea (AAD). We evaluated the usefulness of two rapid immunoassays [i.e., C. DIFF QUIK CHEK COMPLETE® (QUIK CHEK) and GE test immunochromato-CD GDH/TOX「Nissui」(GE test)] in the detection of C. difficile toxins and glutamate dehydrogenase (GDH) in stool specimens. Compared with the results obtained from toxigenic cultures, the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of toxin detection were 41.9, 100, 100, and 81.9 for QUIK CHEK and 48.8, 100, 100, and 83.7 for the GE test, respectively. The sensitivity of the GE test was approximately 6.9% higher than that of QUIK CHEK. Additionally, compared with the results obtained from toxigenic cultures, the sensitivity, specificity, PPV, and NPV of GDH detection were 90.2, 99.0, 97.9, and 95.4 for QUIK CHEK and 94.1, 95.2, 90.6, and 97.1 for the GE test, respectively. Moreover, the GE test showed a higher detection limit and a lower detection specificity of GDH in C. difficile clinical isolates than QUIK CHEK did. However, we hypothesize that cross-reactions occur during the detection of GDH in the GE test. Additionally, the GE test was more sensitive to C. difficile toxins and GDH than QUIK CHEK. Therefore, we conclude that the GE test is a useful screening kit for the diagnosis of C. difficile infections. However, we think that the GDH detection performance should be optimized.</p>

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