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Journal of clinical microbiology v.55 no.2, 2017년, pp.403 - 411   SCI SCIE
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Detection of Clostridium difficile in Feces of Asymptomatic Patients Admitted to the Hospital

Terveer, Elisabeth M. (Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands ); Crobach, Monique J. T. (Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands ); Sanders, Ingrid M. J. G. (Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands ); Vos, Margreet C. (Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands ); Verduin, Cees M. (Department of Microbiology and Infection Prevention, Amphia Hospital, Breda, the Netherlands ); Kuijper, Ed J. (Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands );
  • 초록  

    Recent evidence shows that patients asymptomatically colonized with Clostridium difficile may contribute to the transmission of C. difficile in health care facilities. Additionally, these patients may have a higher risk of developing C. difficile infection. The aim of this study was to compare a commercially available PCR directed to both toxin A and B ( artus C. difficile QS-RGQ kit CE; Qiagen), an enzyme-linked fluorescent assay to glutamate dehydrogenase (GDH ELFA) (Vidas, bioMérieux), and an in-house-developed PCR to tcdB , with (toxigenic) culture of C. difficile as the gold standard to detect asymptomatic colonization. Test performances were evaluated in a collection of 765 stool samples obtained from asymptomatic patients at admission to the hospital. The C. difficile prevalence in this collection was 5.1%, and 3.1% contained toxigenic C. difficile . Compared to C. difficile culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C. difficile GDH ELFA were 87.2%, 91.2%, 34.7%, and 99.3%, respectively. Compared with results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of the commercially available PCR and the in-house PCR were 95.8%, 93.4%, 31.9%, 99.9%, and 87.5%, 98.8%, 70%, and 99.6%, respectively. We conclude that in a low-prevalence setting of asymptomatically colonized patients, both GDH ELFA and a nucleic acid amplification test can be applied as a first screening test, as they both display a high NPV. However, the low PPV of the tests hinders the use of these assays as stand-alone tests.


  • 주제어

    Clostridium difficile .   asymptomatic .   carrier .   diagnostics.  

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