Akamatsu Yukinobu, Morishita Shota, Chikumi Hiroki, Okamoto Ryo, Okada Kensaku, Kitaura Tsuyoshi, Miyake Naomi, Yamaguchi Kosuke, Nakamoto Masaki, Shimohiro Hisashi, Takata Miyako, Yamasaki Akira, Burioka Naoto, Shimizu Eiji
Center for Infectious diseases, Tottori University Hospital.
Division of Clinical Laboratory, Tottori University Hospital.
J Med Invest. 2018;65(1.2):131-135. doi: 10.2152/jmi.65.131.
Clostridium difficile (C. difficile)-associated diarrhea (CDAD) is a challenging nosocomial infectious disease. C. DIFF Quik Chek Complete assay is widely used to detect glutamate dehydrogenase (GDH) antigen and toxin A/B of C. difficile simultaneously. However, the interpretation of GDH positive/toxin negative results is problematic. We performed a retrospective study of patients with GDH positive/toxin negative results to determine the probability of detecting toxigenic C. difficile and its risk factors. Between April 2012 and March 2017, we investigated cultures of fecal specimens followed by toxin detection tests. The clinical histories of patients with and without toxigenic C. difficile were compared using univariate- and multivariate-analyses. In total, 2675 patients were examined using C. Diff Quik Chek Complete assay. Among 356 GDH positive/toxin negative patients, cultures were performed in 220 cases and toxigenic C. difficile was recovered from 139 (63.2%) specimens. Patients with toxigenic C. difficile had significantly lower body mass index than those without. Over half the GDH positive/toxin negative patients were infected with toxigenic C. difficile. Lower BMI was a CDAD risk factor in this patient population. These data can be utilized to initiate isolation and clinical interventions before confirmatory test results are available. J. Med. Invest. 65:131-135, February, 2018.
艰难梭菌相关性腹泻（CDAD）是一种具有挑战性的医院感染性疾病。艰难梭菌快速检测综合检测法被广泛用于同时检测艰难梭菌的谷氨酸脱氢酶（GDH）抗原和毒素A/B。然而，GDH阳性/毒素阴性结果的解读存在问题。我们对GDH阳性/毒素阴性结果的患者进行了一项回顾性研究，以确定检测产毒艰难梭菌的概率及其危险因素。在2012年4月至2017年3月期间，我们对粪便标本进行培养，随后进行毒素检测试验。使用单因素和多因素分析比较了有无产毒艰难梭菌患者的临床病史。总共2675例患者使用艰难梭菌快速检测综合检测法进行了检查。在356例GDH阳性/毒素阴性患者中，220例进行了培养，139例（63.2%）标本中分离出产毒艰难梭菌。产毒艰难梭菌患者的体重指数显著低于无产毒艰难梭菌患者。超过一半的GDH阳性/毒素阴性患者感染了产毒艰难梭菌。较低的体重指数是该患者群体中CDAD的一个危险因素。这些数据可用于在获得确诊检测结果之前启动隔离和临床干预措施。《医学调查杂志》65:131 - 135，2018年2月。
