Evaluation of antigen‐positive toxin‐negative enzyme immunoassay results for the diagnosis of toxigenic Clostridium difficile infection

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  • Akamatsu Yukinobu
    Center for Infectious diseases, Tottori University Hospital
  • Morishita Shota
    Center for Infectious diseases, Tottori University Hospital Division of Clinical Laboratory, Tottori University Hospital
  • Chikumi Hiroki
    Center for Infectious diseases, Tottori University Hospital
  • Okamoto Ryo
    Center for Infectious diseases, Tottori University Hospital
  • Okada Kensaku
    Center for Infectious diseases, Tottori University Hospital
  • Kitaura Tsuyoshi
    Center for Infectious diseases, Tottori University Hospital
  • Miyake Naomi
    Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine
  • Yamaguchi Kosuke
    Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine
  • Nakamoto Masaki
    Center for Infectious diseases, Tottori University Hospital
  • Shimohiro Hisashi
    Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine
  • Takata Miyako
    Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine
  • Yamasaki Akira
    Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine
  • Burioka Naoto
    Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine
  • Shimizu Eiji
    Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine

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  • Evaluation of antigen-positive toxin-negative enzyme immunoassay results for the diagnosis of toxigenic Clostridium difficile infection

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Abstract

<p>Clostridium difficile (C. difficile)‐associated diarrhea (CDAD) is a challenging nosocomial infectious disease. C. DIFF Quik Chek Complete assay is widely used to detect glutamate dehydrogenase (GDH) antigen and toxin A/B of C. difficile simultaneously. However, the interpretation of GDH positive/toxin negative results is problematic. We performed a retrospective study of patients with GDH positive/toxin negative results to determine the probability of detecting toxigenic C. difficile and its risk factors. Between April 2012 and March 2017, we investigated cultures of fecal specimens followed by toxin detection tests. The clinical histories of patients with and without toxigenic C. difficile were compared using univariate‐ and multivariate‐analyses. In total, 2675 patients were examined using C. Diff Quik Chek Complete assay. Among 356 GDH positive/toxin negative patients, cultures were performed in 220 cases and toxigenic C. difficile was recovered from 139 (63.2%) specimens. Patients with toxigenic C. difficile had significantly lower body mass index than those without. Over half the GDH positive/toxin negative patients were infected with toxigenic C. difficile. Lower BMI was a CDAD risk factor in this patient population. These data can be utilized to initiate isolation and clinical interventions before confirmatory test results are available. J. Med. Invest. 65:131‐135, February, 2018</p>

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