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Multicenter comparison of five assays for detection of Clostridium difficile



Multicenter comparison of five assays for detection of Clostridium difficile



Abstracts of the General Meeting of the American Society for Microbiology 102: 132-133



Background: Recent findings support the need to test for both toxin A and B to optimize detection of C. difficile, particularly in the pediatric population. To ensure we were maximizing identification of positive patients, we evaluated 5 assays including one that detects toxins A and B, one that detects toxin A and a C. difficile common antigen, and assays in use at the respective hospitals participating in the study. Methods: 338 fresh stool specimens were tested using Techlab TOX A/B Test (TA/B) and Biosite Triage Panel (TA/Ag), and at least one of the following: Bartels Toxin A EIA (BA), BD Culturette Brand Toxin CD (BDA), and Alexon-Trend ProSpecT II Toxin A Microplate Assay (PSIIA). A specimen was considered positive when at least 2 of 3 assays were positive or culture and PCR were positive. Results: 275/338 (81.4%) specimens were concordant positive (12.4%) and negative (86.6%), respectively. Sensitivity, specificity, predictive values (+) and (-) for each assay were: BA 64.9%, 99.0%, 96.0%, and 88.4%; BDA 77.8%, 98.8%, 93.3%, and 95.3%; PSIIA 55.8%, 98.3%, 88.9%, and 90.4%; TA/B 69.2%, 99.6%, 97.8%, and 92.9%; and TA/Ag 98.5%, 93.2%, 78.1%, and 100%, respectively. Conclusion: All assay sensitivities were less than 77.8% except the TA/Ag (98.5%), designed to detect toxin A and C. difficile common antigen. 26 of 33 initial TA/Ag false positive specimens submitted for culture and PCR resolution, were identified as true positives. Only one specimen was negative by all of the toxin A assays, but positive by TA/B, suggesting a low prevalence of toxin B strains in the population tested. Further discussion on the clinical utility of a sensitive assay for C. difficile will be presented.

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Accession: 035349751

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