King's College, London and Guy's & St. Thomas' NHS Foundation Trust, London, UK.
J Hosp Infect. 2011 Sep;79(1):4-7. doi: 10.1016/j.jhin.2011.03.030. Epub 2011 Jul 2.
Recent studies have shown poor performance of commonly used toxin enzyme immunoassays (EIAs) for laboratory testing for Clostridium difficile infection (CDI). In 2009-2010, the UK Health Protection Agency and the European Society of Clinical Microbiology and Infectious Diseases stated that toxin EIA testing alone is suboptimal, and recommended a two-step testing protocol (i.e. screening with one method and confirming the results with another method). All acute English National Health Service trusts were surveyed to determine their testing methods and positivity rates using freedom of information requests. Replies were received from 168 of 170 trusts (99% response rate). Seventy percent of trusts were using a toxin EIA as a standalone testing method, with positive predictive values (PPVs) as low as 20% in some cases. The mean positivity rate decreased from 6.45% in 2008 to 4.47% in 2009, which will have a negative effect on the PPVs of these tests. The UK Department of Health publishes CDI rates as a measure of quality of care and good infection control practice. However, this may not provide valid comparisons because of the wide disparity between testing methods. The present study demonstrates wide variation in testing practices for CDI in England, and laboratories should reconsider their current testing strategies.
最近的研究表明，常用于检测艰难梭菌感染（CDI）的毒素酶免疫分析（EIA）表现不佳。2009-2010 年，英国卫生保护局和欧洲临床微生物学和传染病学会表示，单独进行毒素 EIA 检测效果不佳，建议采用两步检测方案（即用一种方法进行筛查，用另一种方法确认结果）。通过信息自由请求对所有英国国家卫生服务体系急性信托基金进行了调查，以确定其检测方法和阳性率。在收到的 170 家信托基金中，有 168 家（99%的回复率）做出了回应。70%的信托基金使用毒素 EIA 作为单一的检测方法，在某些情况下，阳性预测值（PPV）低至 20%。阳性率从 2008 年的 6.45%降至 2009 年的 4.47%，这将对这些检测的阳性预测值产生负面影响。英国卫生部将 CDI 发病率作为衡量护理质量和良好感染控制实践的指标。然而，由于检测方法之间存在很大差异，这可能无法提供有效的比较。本研究表明，英国各地对 CDI 的检测实践存在广泛差异，实验室应重新考虑其当前的检测策略。
