Barbut F, Delmée M, Brazier J S, Petit J C, Poxton I R, Rupnik M, Lalande V, Schneider C, Mastrantonio P, Alonso R, Kuipjer E, Tvede M
Laboratory of Microbiology, Center Hospitalier Universitaire Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Clin Microbiol Infect. 2003 Oct;9(10):989-96. doi: 10.1046/j.1469-0691.2003.00683.x.
To conduct a survey of the methods used in clinical microbiology laboratories in Europe to diagnose infection with Clostridium difficile.
A questionnaire was devised and sent to a co-ordinating member of the Study Group in each of eight European countries. This co-ordinator was in charge of forwarding the questionnaire to hospital laboratories arbitrarily selected. The number of laboratories in each country was determined on the basis of one laboratory for 10,000 beds of hospitalization. This questionnaire covered different aspects pertaining to Clostridium difficile associated to diarrhea (CDAD) diagnosis such as circumstances of request, criteria used for undertaking C. difficile investigations, methods used for the diagnosis, etc.
A total of 212 questionnaires were completed and submitted for analysis: 87.7% of laboratories reported routinely performing C. difficile diagnostic tests. Methods used included toxin detection (93%), culture (55%), and glutamate dehydrogenase (GDH) detection (5.9%). Among the laboratories detecting toxins, different enzyme immunoassays (EIA) and cytotoxicity assays were used in 79% and 17.3% of cases, respectively. Among the different strategies reported, 4.8% were considered suboptimal for the diagnosis of C. difficile infections, but marked discrepancies could be observed between countries. The overall incidence (median) of CDAD was estimated at 1.1 for 1,000 patient admissions.
The results of this study suggest marked discrepancies between laboratories and also between countries regarding the criteria by which C. difficile is investigated for, and the methods and the strategies that are used for the diagnosis of C. difficile. These discrepancies could be explained by the lack of clear guidelines for C. difficile diagnosis in each country, and by the importance that physicians attach to C. difficile. Precise guidelines for C. difficile diagnosis would be the first step to make possible accurate comparison of the incidence and the epidemiology of CDAD from one hospital to another or from one country to another.
对欧洲临床微生物学实验室用于诊断艰难梭菌感染的方法进行一项调查。
设计了一份问卷并发送给八个欧洲国家中每个国家研究小组的一名协调成员。该协调员负责将问卷转发给随机选择的医院实验室。每个国家的实验室数量根据每10000张住院床位配备一个实验室来确定。这份问卷涵盖了与艰难梭菌相关性腹泻（CDAD）诊断相关的不同方面，如申请情况、进行艰难梭菌调查所使用的标准、诊断方法等。
共完成并提交了212份问卷用于分析：87.7%的实验室报告常规进行艰难梭菌诊断检测。所使用的方法包括毒素检测（93%）、培养（55%）和谷氨酸脱氢酶（GDH）检测（5.9%）。在检测毒素的实验室中，分别有79%和17.3%的情况使用了不同的酶免疫测定（EIA）和细胞毒性测定。在所报告的不同策略中，4.8%被认为对艰难梭菌感染的诊断并非最佳，但各国之间存在明显差异。CDAD的总体发病率（中位数）估计为每1000例患者入院中有1.1例。
本研究结果表明，在实验室之间以及国家之间，对于艰难梭菌调查的标准、用于诊断艰难梭菌的方法和策略存在明显差异。这些差异可能是由于每个国家缺乏明确的艰难梭菌诊断指南，以及医生对艰难梭菌的重视程度不同所致。制定精确的艰难梭菌诊断指南将是实现准确比较不同医院或不同国家之间CDAD发病率和流行病学情况的第一步。
