GDH 和毒素免疫检测用于艰难梭菌（梭状芽孢杆菌属）感染的诊断并非“一刀切”的筛选检测方法。
GDH and toxin immunoassay for the diagnosis of Clostridioides (Clostridium) difficile infection is not a 'one size fit all' screening test.
机构信息
Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
出版信息
Diagn Microbiol Infect Dis. 2019 Jun;94(2):109-112. doi: 10.1016/j.diagmicrobio.2018.12.010. Epub 2018 Dec 29.
Diagnosing Clostridioides (Clostridium) difficile infection is challenged by lack of a clear gold standard. We sought to determine if the two-step algorithm (screening GDH and toxin lateral flow assay followed by tcdB PCR) would have adequate clinical performance at a tertiary care center. Of 486 patients, 310 (63.8%) were immunocompromised. Of 150 PCR-positive specimens, 52 (34.7%) were toxin-positive and 126 (84.0%) were GDH positive. Positive GDH or toxin results corresponded to lower PCR cycle threshold values (P < 0.01). PCR-positive patients had more frequently documented antibiotic usage (78.4% vs 66.9%, P = 0.05) and diarrhea (91.0% vs. 79.4%, P < 0.01) and less frequent alternate etiologies of diarrhea (27.3% vs. 41.1%, P = 0.004) or laxative use (24.6% vs 36.1%, P = 0.02). Toxin positivity was associated with antibiotic use (P < 0.01), but not with neutropenia, diarrhea, malignancy, or chemotherapy (P > 0.05). The application of the 2-step algorithm should be thoroughly evaluated in immunocompromised patient populations before implementation.
诊断艰难梭菌（梭状芽孢杆菌）感染存在缺乏明确金标准的挑战。我们旨在确定两步算法（检测谷氨酸脱氢酶和毒素侧向流动检测，然后进行 tcdB PCR）在三级保健中心是否具有足够的临床性能。在 486 名患者中，310 名（63.8%）免疫功能低下。在 150 份 PCR 阳性标本中，52 份（34.7%）毒素阳性，126 份（84.0%）谷氨酸脱氢酶阳性。阳性谷氨酸脱氢酶或毒素结果与较低的 PCR 循环阈值相对应（P<0.01）。PCR 阳性患者更频繁地记录抗生素使用（78.4%比 66.9%，P=0.05）和腹泻（91.0%比 79.4%，P<0.01），较少记录腹泻的其他病因（27.3%比 41.1%，P=0.004）或泻药使用（24.6%比 36.1%，P=0.02）。毒素阳性与抗生素使用相关（P<0.01），但与中性粒细胞减少症、腹泻、恶性肿瘤或化疗无关（P>0.05）。在实施前，应在免疫功能低下患者人群中彻底评估两步算法的应用。
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