Munro R, Foldes M, Morris G
Bacteriology Department, Westmead Hospital, New South Wales, Australia.
Pathology. 1988 Oct;20(4):349-52. doi: 10.3109/00313028809085217.
We present here the results of an evaluation of a rapid latex test for detection of Cl. stridium difficile-associated in comparison with our standard cytotoxin assay and culture for C. difficile. Some 515 diarrheal stools were examined. C. difficile was cultured from 70 specimens (13.5%); 53 specimens (10.2%) were positive with the latex test, and 50 (9.6%) by cytotoxin assay. The latex test did not differ significantly from the cytotoxin assay in sensitivity or specificity compared to culture results. There was also no significant difference in the specificity of the latex test compared to cytotoxin assay in patients in whom the diagnosis of C. difficile-associated diarrhea was negative. Positive and negative predictive values of the latex test for C. difficile-associated diarrhea were similar to those of cytotoxin assay. The latex test thus appears to be a rapid and practical test for the laboratory diagnosis of C. difficile-associated diarrhea. To optimize specificity and sensitivity its use should be restricted to patients where the diagnosis is strongly suspected and a rapid answer is required. As it does not distinguish between toxigenic virulent C. difficile strains and non-toxigenic avirulent strains, it would seem prudent to confirm positive results subsequently by demonstrating in-vivo or in-vitro cytotoxin production.
我们在此展示了一项针对艰难梭菌相关性检测的快速乳胶试验的评估结果，该试验与我们用于艰难梭菌检测的标准细胞毒素检测法及培养法进行了对比。共检测了约515份腹泻粪便样本。从70份样本（13.5%）中培养出艰难梭菌；乳胶试验53份样本（10.2%）呈阳性，细胞毒素检测法50份样本（9.6%）呈阳性。与培养结果相比，乳胶试验在敏感性或特异性方面与细胞毒素检测法并无显著差异。在艰难梭菌相关性腹泻诊断为阴性的患者中，乳胶试验与细胞毒素检测法的特异性也没有显著差异。乳胶试验对艰难梭菌相关性腹泻的阳性和阴性预测值与细胞毒素检测法相似。因此，乳胶试验似乎是一种用于艰难梭菌相关性腹泻实验室诊断的快速且实用的检测方法。为优化特异性和敏感性，其应用应限于高度怀疑诊断且需要快速结果的患者。由于它无法区分产毒的致病性艰难梭菌菌株和不产毒的非致病性菌株，后续通过证明体内或体外细胞毒素产生来确认阳性结果似乎更为谨慎。
