Lanzendörfer H, Wüst J, Altwegg M
Institut für Medizinische Mikrobiologie, Universität Zürich.
Schweiz Rundsch Med Prax. 1991 Jan 8;80(1-2):15-9.
This paper compares three common methods for the detection of Clostridium difficile, i.e. latex agglutination, culture and cytotoxic activity. The sensitivity of the latex agglutination test alone is 70%, of the culture 100% and of the cytotoxin test 66%. Specificities are 93, 96 and 100%, respectively. The latex agglutination has positive and negative predictive values of 58 and 96%; the respective values for the culture are 77 and 100%, for the cytotoxin assay 100 and 96%. Whereas all tests are fairly reliable for the exclusion of diarrhea associated to Clostridium difficile (CAD), the positive predictive values of latex agglutination and culture are too low. If one requests two positive test results for proof of CAD, about two third of all cases are detected by any combination of laboratory tests, while the specificity approaches 100%. We recommend that two of the three tests are performed; the choice is influenced by the possibilities of the laboratory.
本文比较了检测艰难梭菌的三种常用方法，即乳胶凝集试验、培养法和细胞毒性活性检测。单独的乳胶凝集试验敏感性为70%，培养法为100%，细胞毒素检测为66%。特异性分别为93%、96%和100%。乳胶凝集试验的阳性和阴性预测值分别为58%和96%；培养法的相应值为77%和100%，细胞毒素检测为100%和96%。虽然所有检测对于排除艰难梭菌相关性腹泻（CAD）都相当可靠，但乳胶凝集试验和培养法的阳性预测值过低。如果要求两项检测结果均为阳性才能确诊CAD，那么通过任何实验室检测组合可检测出约三分之二的病例，而特异性接近100%。我们建议进行三项检测中的两项；具体选择受实验室条件影响。
