DOI QR코드

DOI QR Code

Evaluation of the Usefulness of GDH & Toxin Test for the Diagnosis of Clostridioides difficile in a Tertiary Hospital in Seoul

  • Joo, Ho-Joong (Department of Laboratory Medicine, Samsung Medical Center) ;
  • Kim, Sang-Ha (Department of Laboratory Medicine, Konyang University Hospital) ;
  • Kwon, Pil-Seung (Department of Clinical Laboratory Science, Wonkwang Health Science University) ;
  • Ryu, Jae-Ki (Department of Biomedical Laboratory Science, College of Natural Science, Gimcheon University) ;
  • Yook, Keun-Dol (Department of Clinical Laboratory Science, Daejeon Health Institute of Technology) ;
  • Yu, Young-Bin (Department of Biomedical Laboratory Science, College of Medical Sciences, Konyang University) ;
  • Kim, Young-Kwon (Department of Health Sciences, The Graduate School of Konyang University)
  • Received : 2020.06.11
  • Accepted : 2020.08.26
  • Published : 2020.09.30

Abstract

The purpose of this study was to evaluate GDH & Toxin (GDT) tests for the identification of the presence of Clostridioides difficile (C. difficile) as well as to detect whether any toxin was present in the feces of patients suspected of diarrhea associated with C. difficile. Data related to the results of toxin and culture (TC) tests and GDT tests conducted on patients with diarrhea and suspected CDI between January 2017 and august 2018, positive test rates, patient ages and sexes, whether the patients were hospitalized, and turnaround time (TAT) were analyzed retrospectively. Of the 7,554 total tests conducted for CDI diagnosis, 1,010 TC tests (14.9%) were positive, while 92 GDT tests (12.0%) were positive. Of these positive cases, 815 (80.7%) identified through TC test and 80 (87%) identified through GDT test were inpatients. also, among the patients with positive test results, 497 (49.2%) diagnosed through TC test and 45 (48.9%) diagnosed through GDT test were aged 61 years or older. The total time required to complete a TC test was 83.6 hours, while the time required for a GDT test was 11.2 hours, equating to an approximately three-day difference between the two tests. The detection of toxin-producing C. difficile is important in CDI diagnosis, but the commonly used Enzymeimmunoassay (EIA) toxin tests with low sensitivity result in delayed CDI diagnosis time. Therefore, primary screening tests for CDI diagnosis using the GDT method and secondary tests using additional methods are considered most effective.

Keywords

References

  1. Bartlett JG. Antibiotic-associated diarrhea. N Engl J Med. 2002. 346: 334-339. https://doi.org/10.1056/NEJMcp011603
  2. Cho HJ, Ryoo E, Sun YH, Cho KH, Son DW, Tchah H. Epidemiology and Clinical Characterist ics of Clostridium difficileassociated diarrhea in Children: Comparison between Community And hospital-acquired Infection. Kjpgn. 2010. 13: 146-153.
  3. Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis. 2012. 55: 88-92.
  4. Hensgens MP, et al. "Clostridium difficile infection in the commnity: a zoonotic disease?". Clin Microbiol Infect. 2012.18: 635-645. https://doi.org/10.1111/j.1469-0691.2012.03853.x
  5. Jeon SR. Clinical Characterization of Clostridium difficile Infection in Elderly Patients. Korean J Gastroenterol. 2016. 67: 61-63. https://doi.org/10.4166/kjg.2016.67.2.61
  6. Jumaa P, Wren B, Tabaqchali S. Epidemiology and typing of Clostridium difficile. European Journal of Gastroenterology & Hepatology. 1996. 8: 1035-1040. https://doi.org/10.1097/00042737-199611000-00002
  7. Kelly CP, LaMont JT. Clostridium difficile-more difficult than ever. The New England Journal of Medicine. 2008. 359: 1932-1940. https://doi.org/10.1056/NEJMra0707500
  8. Lo Vecchio A, Zacur GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol. 2012. 28: 1-9. https://doi.org/10.1097/MOG.0b013e32834bc9a9
  9. Morris AM, Jobe BA, Stoney M, Sheppard BC, Deveney CW, Deveney KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Archives of surgery (Chicago, Ill: 1960). 2002. 137: 1096-1100. https://doi.org/10.1001/archsurg.137.10.1096
  10. Oldfield EC, Oldfield EC, Johnson DA. Clinical update for the diagnosis an d treatment of Clostridium difficile infection. World J Gastrointest Ph armacol Ther. 2014. 5: 1-26. https://doi.org/10.4292/wjgpt.v5.i1.1
  11. Park HS, Han DS. Management of Antibiotics-Associated Diarrhea. Korean J Gastroenterol. 2009. 54: 5-12. https://doi.org/10.4166/kjg.2009.54.1.5
  12. Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, et al. Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era. JAMA Internal Medicine. 2015. 175: 1792-1801. https://doi.org/10.1001/jamainternmed.2015.4114
  13. Poxton IR, McCoubrey J, Blair G. The pathogenicity of Clostridiu difficile. ClinMicrobiol Infect. 2001. 7: 421-427. https://doi.org/10.1046/j.1198-743x.2001.00287.x
  14. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. American Journal of Gastroenterology. 2013. 108: 478-498. https://doi.org/10.1038/ajg.2013.4