Diagnostic Value of Simple Immune-chromatographic Test for Rapid Detection of Clostridium difficile Infection

Document Type : New and original researches in the field of Microbiology.

Authors

1 Clinical and Chemical Pathology Department, Faculty of Medicine, Banha University

2 Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Banha University

Abstract

Background: Clostridium difficile is a very important cause fo antibiotic-associated
diarrhea and pseudomembranous colitis. Diagnosis of C. difficile mainly relies on toxin
detection in stool specimens from individuals with suspected disease. Objective: is to
introduce to our microbiology laboratory of a simple test that may be rapid, cheap and
easily manipulated than conventional methods for effective diagnosis of C.
difficile infection. Methodology: Stool samples from sixty eight hospitalized patients
developing CDI like symptoms were subjected to culture on CCFA, detection of toxins A
and/or B by X/pect test (directly from stool samples and from culture isolates) and Real
time PCR for detection of tcdA/ tcdB toxin genes. Results: Toxigenic C. difficile was
detected in (22.1%) of suspected cases using tcdA/ tcdB real time PCR which was the
gold standard method in our study. The positive rate for the direct X/pect test was 13.2%
and for the indirect test was 14.7%. The sensitivity of direct X/pect test was 60%,
specificity was 100%, PPV was 100%, and NPV was 89.8% with 91.2% agreement
between the direct assay and real time PCR. While, the validity values for the indirect
test was 66.7%, 100%, 100% & 91.4% for sensitivity, specificity, PP and NP values
respectively, with 92.6% agreement between both assays. Antibiotic intake and recent
hospitalization were the most commonly encountered risk factors, followed by number of
hospitalization days. Penicillins and cephalosporins were the most frequently associated
antibiotics, followed by clindamycin Conclusions: Using X/pect test can combine
accurate results with simple procedure that offers results within 20 minutes. Although it
is accompanied with low sensitivity and high rate of false-negative results, X/pect test
may be of great benefit to practitioners particularly when you need STAT testing or 24
hour/ 7 days coverage. Further, it can be used as a preliminary screening approach
allowing patients to be treated early and correctly in order to shorten the duration of
symptoms and avoid complications.

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