Rapid identification of Clostridium difficile by direct detection of volatile organic acids from primary isolation media.

Makin, Thomas

doi:10.1136/jcp.37.6.711

Cited by 16 publications

(4 citation statements)

References 11 publications

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“…Potvliege et al used GLC to detect isocaproic acid produced by C. difficile and reported a sensitivity of 61% and a specificity of 95% (24). Other researchers have used more complicated GLC procedures but did not achieve high sensitivity (3,4,17). Pepersack et al used a more sensitive chromatograph and reported a sensitivity of 100% and a specificity of 92% (23).…”

Section: Discussionmentioning

confidence: 99%

Identification of Clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography

Johnson¹,

McFarland²,

Dearing³

et al. 1989

J Clin Microbiol

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We have developed a sensitive and specific method for the identification of Clostridium difficile in stool specimens based on the detection of metabolic breakdown products of the organism by gas-liquid chromatography after incubation of stool samples in a selective broth medium containing cefoxitin. Use of this approach to test samples from two different populations of patients at separate medical centers showed this method to be superior to plate cultures or cytotoxin testing alone for both populations. The combined results from the two patient populations showed that 225 of 226 confirmed isolates were identified correctly, resulting in a sensitivity of 99.6% and a specificity of 99.0%. This method eliminates the delay caused by subculturing for tests requiring a pure isolate. The culture phase amplifies even low numbers of C. difficile in fecal samples (due to low in vivo concentrations or delayed transport) and thus increases sensitivity. Other advantages include the ability to detect C. difficile in the mixed flora of the stool and the ability of most clinical laboratories to use this procedure. Given the complexities of the detection of C. difficile toxins and the increasing importance of this organism as a nosocomical agent, culture-based methods remain the preferred approach to screening and routine workup for cases of diarrhea.

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Section: Discussionmentioning

confidence: 99%

Identification of Clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography

Johnson¹,

McFarland²,

Dearing³

et al. 1989

J Clin Microbiol

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“…In addition, the concentrations of cycloserine and cefoxitin and the type of basal medium affect the recovery rate and the phenotypic properties (e.g., the intensity of the fluorescence) exhibited by the organism (130,131). Some of the unusual metabolic products (e.g., p-cresol and isocaproic acid) produced by C. difficile have been suggested as markers for the organism (54, 84,129,134,150,171,175,182). The detection of these substances is not specific enough to be used as a marker for clinical diagnosis.…”

Section: Isolation and Identification Of The Organismmentioning

confidence: 99%

Clostridium difficile: its disease and toxins

1988

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Clostridium difficile is the etiologic agent of pseudomembranous colitis, a severe, sometimes fatal disease that occurs in adults undergoing antimicrobial therapy. The disease, ironically, has been most effectively treated with antibiotics, although some of the newer methods of treatment such as the replacement of the bowel flora may prove more beneficial for patients who continue to relapse with pseudomembranous colitis. The organism produces two potent exotoxins designated toxin A and toxin B. Toxin A is an enterotoxin believed to be responsible for the diarrhea and mucosal tissue damage which occur during the disease. Toxin B is an extremely potent cytotoxin, but its role in the disease has not been as well studied. There appears to be a cascade of events which result in the expression of the activity of these toxins, and these events, ranging from the recognition of a trisaccharide receptor by toxin A to the synergistic action of the toxins and their possible dissemination in the body, are discussed in this review. The advantages and disadvantages of the various assays, including tissue culture assay, enzyme immunoassay, and latex agglutination, currently used in the clinical diagnosis of the disease also are discussed.

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“…In addition, the concentrations of cycloserine and cefoxitin and the type of basal medium affect the recovery rate and the phenotypic properties (e.g., the intensity of the fluorescence) exhibited by the organism (130,131). Some of the unusual metabolic products (e.g., p-cresol and isocaproic acid) produced by C. difficile have been suggested as markers for the organism (54,84,129,134,150,171,175,182). The detection of these substances is not specific enough to be used as a marker for clinical diagnosis.…”

Section: Counterimmunoelec-mentioning

confidence: 99%