Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review

Planche, Tim; Aghaizu, Adamma; Holliman, R E; Riley, Peter; Poloniecki, Jan; Breathnach, Aodhán S.; Krishna, Sanjeev

doi:10.1016/s1473-3099(08)70233-0

Cited by 296 publications

(225 citation statements)

References 21 publications

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“…7 Sub-optimal case ascertainment, either due to inadequate laboratory diagnosis or lack of clinical suspicion means that the true burden of CDI is unclear. [9][10][11][12] A recent point prevalence study in Spain found that 66% of CDI patients on a single day were undiagnosed or misdiagnosed, due either to lack of clinical suspicion (47%) or inadequate laboratory testing (19%). 9 Optimal laboratory diagnosis of CDI depends on testing the right patients, at the right time with the right tests.…”

Section: Introductionmentioning

confidence: 99%

Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Davies

Longshaw

Davis

et al. 2014

The Lancet Infectious Diseases

343

309

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Section: Introductionmentioning

confidence: 99%

Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Davies

Longshaw

Davis

et al. 2014

The Lancet Infectious Diseases

343

309

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“…and a specifi city of 83 -98 % compared with CCNA reference testing ( 18 ). Two major advances in the laboratory diagnosis are the use of GDH detection in stools as a means of screening for CDI and the development of NAATs such as PCR to detect toxigenic strains of C. diffi cile.…”

mentioning

confidence: 99%

“…Additionally, antibodies against C. diffi cile GDH may cross react with the same enzyme in other clostridial species ( 22 ). Reports and meta-analyses detail sensitivity ranging from 75 % to > 90 % with a negative predictive value of between 95 % and 100 % , although its positive predictive values have been found to be as low as 50 % ( 18,23 ). Th e sensitivity of GDH antigen detection has led to its use as a screening test as part of CDI testing algorithms, although it should be noted that as many as 10 % of patients with toxigenic organisms can be missed by this method.…”

mentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,457

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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“…Su utilización incrementó la detección de la infección por C. difficile, con lo cual se pudo optimizar el tratamiento y adoptar las medidas de aislamiento oportunas en el caso de muchos pacientes. Sin embargo, en algunos estudios se ha reportado que puede haber pacientes asintomáticos, cuya infección no se detecta con el uso exclusivo de técnicas basadas en la PCR, por lo cual algunas guías recomiendan el uso de algoritmos de múltiples pasos que incluyen más de un método diagnóstico: PCR y ELISA o el empleo de la glutamato deshidrogenasa (32,33).…”

Section: Discussionunclassified

Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

Gualtero¹,

Abril²,

Camelo³

et al. 2017

biomedica

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Introducción. Clostridium difficile es el principal responsable de la diarrea asociada al uso de antibióticos. En Colombia y en Latinoamérica, el conocimiento sobre el comportamiento epidemiológico de la infección por C. difficile todavía es limitado.Objetivo. Describir las características de una serie de pacientes con infección por C. difficile.Materiales y métodos. Se hizo un estudio descriptivo de una serie de casos de pacientes con infección por C. difficile atendidos en la Fundación Clínica Shaio, entre enero de 2012 y noviembre de 2015.Resultados. Se estudiaron 36 pacientes con una edad promedio de 65 años. Se determinaron los siguientes factores relacionados con la infección por C. difficile: uso previo de antimicrobianos (94,4 %), hospitalización en los últimos tres meses (66,7 %) y uso de inhibidores de la bomba de protones (50 %). Las comorbilidades más comunes fueron la enfermedad renal crónica (41,7 %) y la diabetes mellitus (30,6 %). Los síntomas más frecuentes fueron más de tres deposiciones diarreicas (97,1 %) y dolor abdominal (42,9 %). En cuanto a la gravedad de los casos, 44,4 % se clasificó como leve a moderado, 38,9 % como grave, y 11,1 % como complicado o grave. El método de diagnóstico más utilizado (63,8% de los pacientes) fue la identificación de la toxina mediante reacción en cadena de la polimerasa (PCR). La mortalidad global durante la hospitalización fue de 8 %. Se identificaron cuatro cepas del serotipo NAP1/027 y nueve muestras fueron positivas para la toxina binaria.Conclusión. La infección por C. difficile debe sospecharse en pacientes con deposiciones diarreicas y factores asociados tradicionalmente a esta enfermedad. Se reportó la circulación de cepas hipervirulentas del serotipo NAP1/027 en Colombia, lo cual debe enfrentarse con la vigilancia epidemiológica y el diagnóstico temprano

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Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review

Cited by 296 publications

References 21 publications

Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Characteristics of Clostridium difficile infection in a high complexity hospital and report of the circulation of the NAP1/027 hypervirulent strain in Colombia

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