Schneider Anna, Mól Anna, Lisowska Katarzyna, Jax-Dambek Maria, Lachowicz Dominika, Obuch-Woszczatyński Piotr, Pituch Hanna
Microbiology Clinical Laboratory.
Section for Healthcare-associated Infection Control University Hospital of Lord's Transfiguration in Poznań
Przegl Epidemiol. 2014;68(4):669-74.
Clostridium difficile is a predominant etiological agent of healthcare-associated infectious diarrhea. Immunoenzymatic tests for detecting toxins A/B from faecal samples are still used in routine diagnosis of Clostridium difficile-associated diseases in a number of healthcare centers in Poland. Recently, however, new diagnostic tests were introduced which allow for detecting toxigenic strains of C. difficile in a more effective and precise manner. It is of importance, especially in the light of hypervirulent strain occurrence.
The aim of the present paper was to evaluate the efficacy of three-step algorithm in the diagnosis of Clostridium difficile-associated diseases (CDAD), considering the occurrence of false negative test results for toxins while using exclusively immunoenzymatic tests.
In the present study, faecal samples collected from patients presenting diarrhea were tested. Immunoenzymatic tests were used for detecting glutamate dehydrogenase (GDH) and toxins A/B. Culture and RT-PCR were also employed.
Of 615 study participants, toxigenic strains GDH (+) TOX (+) were identified in 108 patients while for 67 patients, test results remained unspecified GDH (+) TOX (-). Further analysis of unspecified samples revealed 32 patients infected with toxigenic strains, i.e. 22.9% of all positive test results (n=140).
Three-step diagnostic algorithm is an effective and reliable tool for diagnosing C.difficile- associated diseases.
艰难梭菌是医疗保健相关感染性腹泻的主要病原体。在波兰的许多医疗中心，用于检测粪便样本中毒素A/B的免疫酶试验仍用于艰难梭菌相关疾病的常规诊断。然而，最近引入了新的诊断试验，能够以更有效和精确的方式检测艰难梭菌的产毒菌株。这一点很重要，尤其是考虑到高毒力菌株的出现。
本文的目的是评估三步算法在艰难梭菌相关疾病（CDAD）诊断中的有效性，同时考虑仅使用免疫酶试验时毒素检测结果出现假阴性的情况。
在本研究中，对腹泻患者采集的粪便样本进行检测。使用免疫酶试验检测谷氨酸脱氢酶（GDH）和毒素A/B。还采用了培养和逆转录聚合酶链反应（RT-PCR）。
在615名研究参与者中，108名患者鉴定出产毒菌株GDH（+）TOX（+），而67名患者的检测结果仍未明确，为GDH（+）TOX（-）。对未明确样本的进一步分析显示，32名患者感染了产毒菌株，即占所有阳性检测结果（n = 140）的22.9%。
三步诊断算法是诊断艰难梭菌相关疾病的有效且可靠的工具。
