Searching for a Potential Algorithm for Clostridium difficile Testing at a Tertiary Care Hospital: Does Toxin Enzyme Immunoassay Testing Help?

Abstract

is a major contributor to morbidity and mortality in the United States. Methods for identifying the organism in stool include molecular platforms, enzyme immunoassays (EIAs) for toxin, and culture. Controversy persists over whether molecular tests are too sensitive at identifying , and there are questions about how additional laboratory information could inform clinical management and reduce over treatment. The aim of this study was to assess whether clinical factors are related to the toxin status of patients and whether information about toxin status could potentially inform clinical management of patients. A total of 201 PCR-positive stool samples from adult patients at our institution underwent EIA toxin testing. Clinical and laboratory data were collected, and the percentage of PCR-positive/EIA-positive (PCR/EIA) patients and PCR and EIA-negative (PCR/EIA) patients was calculated. Of the 201 samples, 47% were EIA positive and 53% were EIA negative. Although PCR/EIA patients were more likely to have had a prior infection ( = 0.015), there was no statistical difference between the additional data collected that correlated with a positive EIA result. We were unable to show that patients with an EIA result had worse clinical parameters than those with EIA results and concluded that establishing a testing algorithm that included both PCR and EIA testing would not change the clinical management of patients at our hospital.

Evaluation of a Two Step Testing Algorithm to Improve Diagnostic Accuracy and Stewardship of Clostridioides difficile Infections

“…Additionally, this further supports the recommendation for PCR testing alone when pre-test probability is improved with stool submission criteria. [4] Similar to previous studies [11,[13][14], we observed no increase in adverse events when discordant cases were not treated. While this has been previously taken as support that discordant cases are most likely representative of colonization as opposed to true infection, the actual signi cance of these cases is unclear.…”

“…Indeed, several studies found no difference in clinical outcomes between discordant and concordant patients, irrespective of treatment. [11,[13][14] Accurate distinction between colonization and CDI is desirable because it results in cost savings, appropriate antimicrobial stewardship, accurate diagnosis, and decreases risks for vancomycin resistant Enterococcus colonization. [12] Our institution relied on a PCR-only testing strategy at the time of the 2018 guideline publication.…”

Versatile Magnetic Nanoparticles for Spatially Organized Assemblies of Enzyme Cascades: A Comprehensive Investigation of Catalytic Performance

“…[ 1‐2 ] It is attributed commonly to well‐aligned constituent enzymes in multienzyme cascade systems to ensure a series of catalytic reactions concurrently happening and not interfering with each other. [ 3 ] Drawing inspiration from nature, many research groups have been committed to constructing controllable spatial organization for specified enzyme pairs in the engineering applications of industrial manufacturing, [ 4‐5 ] biomedicine, [ 2,6‐7 ] materials, [ 8 ] and biosensors. [ 9‐10 ] These artificial systems include nanoparticles, [ 11 ] crystalline materials, [ 12 ] biomolecular cages, [ 13‐14 ] sol‐gel materials, [ 15‐16 ] LBL assembly materials, [ 17 ] metal‐organic frameworks, [ 14 ] polymersomes, [ 14,18 ] and so on.…”

Significance of a polymerase chain reaction method in the detection of Clostridioides difficile

“…Por otra parte, la detección de cepas con capacidad toxigénica mediante PCR o cultivo no implica necesariamente que haya toxina libre, pudiendo corresponder a casos de colonización, mientras que la citotoxicidad puede deberse a causas distintas al C. difficile . En el estudio de Theiss et al [ 12 ], en la mitad de los pacientes con PCR positiva no se pudo detectar toxina mediante una técnica de enzimoinmunoensayo (EIA), un porcentaje similar al de nuestro estudio. En otro estudio similar, Crobach et al sólo detectaron toxina en menos del 40% de las muestras positivas mediante PCR [ 13 ].…”

“…En nuestro estudio la gran mayoría de las muestras procesadas han sido diarreicas, lo que podría concordar con una clínica compatible con infección, sin embargo, la diarrea podría deberse a otras causas distintas a la acción del C. difficile [ 16 ]. Theiss et al no han observado diferencias en los síntomas ni en las características clínicas de los pacientes en función de si se detectan toxinas o no en las muestras con PCR positiva [ 12 ], lo que complica la identificación de los pacientes realmente infectados. La presencia de síntomas clínicos (fundamentalmente la diarrea) sin otra causa que los justifique puede ayudar a establecer un diagnóstico más fiable de la infección.…”