School of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil.
Alfa Institute of Gastroenterology, Clinical Hospital of the Federal University of Minas Gerais, Minas Gerais, Brazil.
J Gastroenterol Hepatol. 2018 Feb;33(2):393-396. doi: 10.1111/jgh.13901.
Clostridium difficile is a major cause of health care-associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision-making. Conventional enzyme immunoassay (EIA) for toxin detection is currently the most frequently used technique for C. difficile infection (CDI) diagnosis, but its low sensitivity makes the development of an alternative strategy necessary for improving the diagnosis in developing countries.
Between years 2011 and 2015, 154 stool samples from patients with antibiotic-associated diarrhea were examined by toxigenic culture and EIA for the diagnosis of CDI. In the year 2015, when glutamate dehydrogenase (GDH) test was first available in Brazil, 53 of those fecal specimens were also tested by the C. diff Quik Chek Complete rapid immunoassay. At this time, we prospectively assessed the impact of this test on CDI treatment rates before and after it was introduced in clinical practice.
The GDH component of C. diff Quik Chek Complete test had a sensitivity of 100% and specificity of 95.1% compared with toxigenic culture, with 89.8% concordance. The Tox A/B II EIA and the toxin portion of C. diff Quik Chek Complete yielded sensitivities between values of 50-58.3%, with 100% specificities. The introduction of GDH test increased the number of treated patients with CDI from 57.7% to 100%.
Glutamate dehydrogenase test is a reliable method for the diagnosis of CDI and greatly increases the number of properly treated patients with CDI. Therefore, this exam should be considered the mainstay for the laboratory diagnosis of CDI in developing countries.
艰难梭菌是导致医疗保健相关性感染的主要原因，但诊断检测之间的不一致仍然是临床决策的一个持续障碍。目前，用于检测毒素的常规酶联免疫吸附试验（EIA）是诊断艰难梭菌感染（CDI）最常用的技术，但由于其敏感性低，因此有必要开发替代策略来提高发展中国家的诊断水平。
在 2011 年至 2015 年间，对 154 例因抗生素相关性腹泻的患者粪便样本进行了产毒培养和 EIA 检测，以诊断 CDI。在 2015 年，当谷氨酸脱氢酶（GDH）检测在巴西首次可用时，对其中 53 份粪便标本进行了 C. diff Quik Chek Complete 快速免疫检测。此时，我们前瞻性评估了在引入临床实践前后，该检测对 CDI 治疗率的影响。
C. diff Quik Chek Complete 试验的 GDH 组分与产毒培养相比，具有 100%的敏感性和 95.1%的特异性，符合率为 89.8%。Tox A/B II EIA 和 C. diff Quik Chek Complete 的毒素部分的敏感性在 50-58.3%之间，特异性为 100%。GDH 检测的引入使 CDI 治疗患者的数量从 57.7%增加到 100%。
谷氨酸脱氢酶检测是诊断 CDI 的可靠方法，可大大增加 CDI 患者的治疗数量。因此，该检查应被视为发展中国家 CDI 实验室诊断的主要方法。
