The Significance and Utility of a Highly Sensitive PCR Test for the Diagnosis of Clostridium difficile Infection (CDI)

Smith, Becky; Schaefer, Edward H.; Liu, Emelline; Schoonmaker, Michele; Ridgway, Jessica P; Robicsek, Ari; Peterson, Lance R.

doi:10.1093/ofid/ofv133.665

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“…Thus, it is not surprising that those researchers found a high number of positive specimens from patients with no significant diarrhea, given that it is not unusual for hospitalized patients to be colonized with this organism (25). Our own data suggest that PCR-positive, direct stool toxin-negative patients have a significant risk for future complications if not treated (26). We found a significant positive effect of receiving treatment on reducing 90-day readmission for any reason, decreasing the inpatient length of stay (LOS) and total LOS (inpatient plus readmission LOS), and reduced charges in the enzyme-immunoassay-negative (EIA Ϫ )/PCR ϩ group versus the EIA ϩ / PCR ϩ group, suggesting that at least some of these patients actually had clinically significant CDI.…”

Section: Discussionmentioning

confidence: 58%

Evaluation of the cobas Cdiff Test for Detection of Toxigenic Clostridium difficile in Stool Samples

et al. 2017

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Nucleic acid amplification tests (NAATs) are reliable tools for the detection of toxigenic from unformed (liquid or soft) stool samples. The objective of this study was to evaluate performance of the cobas Cdiff test on the cobas 4800 system using prospectively collected stool specimens from patients suspected of having infection (CDI). The performance of the cobas Cdiff test was compared to the results of combined direct and broth-enriched toxigenic culture methods in a large, multicenter clinical trial. Additional discrepancy analysis was performed by using the Xpert Epi test. Sample storage was evaluated by using contrived and fresh samples before and after storage at -20°C. Testing was performed on samples from 683 subjects (306 males and 377 females); 113 (16.5%) of 683 subjects were positive for toxigenic by direct toxigenic culture, and 141 of 682 subjects were positive by using the combined direct and enriched toxigenic culture method (reference method), for a prevalence rate of 20.7%. The sensitivity and specificity of the cobas Cdiff test compared to the combined direct and enriched culture method were 92.9% (131/141; 95% confidence interval [CI], 87.4% to 96.1%) and 98.7% (534/541; 95% CI, 97.4% to 99.4%), respectively. Discrepancy analysis using results for retested samples from a second NAAT (Xpert C. difficile/Epi test; Cepheid, Sunnyvale, CA) found no false-negative and 4 false-positive cobas Cdiff test results. There was no difference in positive and negative results in comparisons of fresh and stored samples. These results support the use of the cobas Cdiff test as a robust aid in the diagnosis of CDI.

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Section: Discussionmentioning

confidence: 58%