Clinical impact of switching conventional enzyme immunoassay with nucleic acid amplification test for suspected Clostridium difficile-associated diarrhea

2013 ◽  
Vol 41 (4) ◽  
pp. 373-375 ◽  
Author(s):  
Steven W. Johnson ◽  
Meganne Kanatani ◽  
Romney M. Humphries ◽  
Daniel Z. Uslan
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Enzyme Immunoassay ◽  
Nucleic Acid Amplification Test ◽  
Clinical Impact ◽  
Nucleic Acid Amplification ◽  
Clostridium Difficile Associated Diarrhea

scholarly journals Nucleic Acid Amplification Test Quantitation as Predictor of Toxin Presence in Clostridium difficile Infection

2017 ◽  
Vol 56 (3) ◽  
Author(s):  
M. J. T. Crobach ◽  
N. Duszenko ◽  
E. M. Terveer ◽  
C. M. Verduin ◽  
E. J. Kuijper
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Characteristic Curve ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
Toxin A ◽  
Toxin B ◽  
Content Type ◽  
Quantitative Results ◽  
Testing Algorithm

ABSTRACT Multistep algorithmic testing in which a sensitive nucleic acid amplification test (NAAT) is followed by a specific toxin A and toxin B enzyme immunoassay (EIA) is among the most accurate methods for Clostridium difficile infection (CDI) diagnosis. The obvious shortcoming of this approach is that multiple tests must be performed to establish a CDI diagnosis, which may delay treatment. Therefore, we sought to determine whether a preliminary diagnosis could be made on the basis of the quantitative results of the first test in algorithmic testing, which provide a measure of organism burden. To do so, we retrospectively analyzed two large collections of samples ( n = 2,669 and n = 1,718) that were submitted to the laboratories of two Dutch hospitals for CDI testing. Both hospitals apply a two-step testing algorithm in which a NAAT is followed by a toxin A/B EIA. Of all samples, 208 and 113 samples, respectively, tested positive by NAAT. Among these NAAT-positive samples, significantly lower mean quantification cycle ( C q ) values were found for patients whose stool eventually tested positive for toxin, compared with patients who tested negative for toxin (mean C q values of 24.4 versus 30.4 and 26.8 versus 32.2; P < 0.001 for both cohorts). Receiver operating characteristic curve analysis was performed to investigate the ability of C q values to predict toxin status and yielded areas under the curve of 0.826 and 0.854. Using the optimal C q cutoff values, prediction of the eventual toxin A/B EIA results was accurate for 78.9% and 80.5% of samples, respectively. In conclusion, C q values can serve as predictors of toxin status but, due to the suboptimal correlation between the two tests, additional toxin testing is still needed.

scholarly journals Clostridium difficile Testing Algorithm: Is There a Difference in Patients Who Test Positive by Enzyme Immunoassay vs. Those Who Only Test Positive by Nucleic Acid Amplification Methodology?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S394-S394
Author(s):  
Jonathan Polak ◽  
Ogheneruona Odili ◽  
Mary Ashleigh Craver ◽  
Anthony Mayen ◽  
Kyle Purrman ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Enzyme Immunoassay ◽  
Serum Lactate ◽  
Nucleic Acid Amplification ◽  
Categorical Variables ◽  
Grant Recipient ◽  
Stool Specimens ◽  
Chi Square Analysis

Abstract Background Testing for Clostridium difficile infection (CDI) commonly involves checking for the presence of toxins A and B by enzyme immunoassay (EIA) or nucleic acid amplification (NAA). The former is very specific, but not very sensitive. The latter is very sensitive. Beginning in 2011, our hospital incorporated an algorithm that involved testing liquid stool specimens for glutamate dehydrogenase (GDH) and toxin by EIA. For discrepant results, the stool specimen was tested for the presence of toxin by NAA. We sought to determine whether there was a difference in the baseline characteristics or outcomes between the two groups. Methods We performed a chart review of all subjects who tested positive for CDI by either method between 2011 and 2016 at Vidant Medical Center, a 909 bed, tertiary care teaching hospital. Testing was only performed on liquid stool specimens. Subjects less than 18 years of age were excluded. Repeat positive specimens were excluded. We collected demographic data including age, gender, baseline temperature, white blood cell count, and serum lactate and albumin. Length of stay and in-hospital mortality were also determined for both groups. Comparison of the two groups was done using t-test for continuous and chi-square analysis for categorical variables. Results Over the 6 year period, there were 535 positive test results. 243 specimens tested positive by EIA/GDH (EIA +); 292 specimens tested positive by GDH/NAA (NAA +). Compared with the EIA + group, the NAA + group was younger (61.8 years vs. 65.1 years, P = 0.01). There were no statistical differences in the presence of abdominal tenderness, temperature &gt;38oC, serum albumin, serum lactate, length of stay, or mortality between the two groups. The EIA + group was statistically more likely to have leukocytosis (WBC &gt;20,000 cells/mm3) at the time of the CDI testing compared with the NAA + group (P = 0.0002). Conclusion There do appear to be some clinical differences in the presentation of subjects who test positive for CDI by EIA/GDH compared with those who test positive only by GDH/NAA. These differences do not appear to affect length of stay or mortality. Disclosures P. P. Cook, Gilead: Grant Investigator, Grant recipient; Merck: Grant Investigator, Grant recipient; Pfizer: Grant Investigator and Shareholder, Grant recipient

Detection of Clostridium difficile in Fecal Specimens: a Comparative Evaluation of Nucleic Acid Amplification Test and Toxigenic Culture

2016 ◽  
Vol 62 (10/2016) ◽  
Author(s):  
Shima Lotfian ◽  
Masoumeh Douraghi ◽  
Amir Aliramezani ◽  
Sedighe Ghourchian ◽  
Abdolfatah Sarrafnejad ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Comparative Evaluation ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
Toxigenic Culture

scholarly journals Evaluation of the QiagenartusC. difficile QS-RGQ Kit for Detection of Clostridium difficile Toxins A and B in Clinical Stool Specimens

2015 ◽  
Vol 53 (6) ◽  
pp. 1942-1944 ◽  
Author(s):  
Nathalie Jazmati ◽  
Pia Wiegel ◽  
Božica Ličanin ◽  
Georg Plum
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
Content Type ◽  
Stool Specimens ◽  
Sensitivity Specificity

We compared the QiagenartusC. difficile QS-RGQ kit, a new nucleic acid amplification test for the detection ofClostridium difficiletoxins in stool specimens, with the Cepheid XpertC. difficiletest. The sensitivity, specificity, positive predictive value, and negative predictive value for the QiagenartusC. difficile QS-RGQ test were 100%, 89.5%, 60.9%, and 100%, and those for the Cepheid XpertC. difficiletest were 100%, 90%, 62.2%, and 100%, respectively.

Failure of Risk-Adjustment by Test Method for C. difficile Laboratory-Identified Event Reporting

2016 ◽  
Vol 38 (1) ◽  
pp. 109-111 ◽  
Author(s):  
Alexandre R. Marra ◽  
Michael B. Edmond ◽  
Bradley A. Ford ◽  
Loreen A. Herwaldt ◽  
Abdullah R. Algwizani ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clostridium Difficile ◽  
Enzyme Immunoassay ◽  
Risk Adjustment ◽  
Test Method ◽  
Infect Control Hosp ◽  
Nucleic Acid Amplification ◽  
Event Reporting ◽  
Current Risk

Using an algorithm including both enzyme immunoassay (EIA) and nucleic acid amplification (NAAT) for Clostridium difficile infection (CDI) diagnosis, we found that the use of NAAT versus EIA almost doubled our hospital-onset CDI laboratory-identified (LabID) event standardized infection ratio (SIR). We recommend that the current risk adjustment approach be modified.Infect Control Hosp Epidemiol 2016:1–3

Reductions in positive Clostridioides difficile events reportable to National Healthcare Safety Network (NHSN) with adoption of reflex enzyme immunoassay (EIA) testing in 13 Atlanta hospitals

2021 ◽  
pp. 1-4
Author(s):  
Dana Goodenough ◽  
Samantha Sefton ◽  
Elizabeth Overton ◽  
Elizabeth Smith ◽  
Colleen S. Kraft ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Enzyme Immunoassay ◽  
Infection Prevention ◽  
Nucleic Acid Amplification Test ◽  
Nucleic Acid Amplification ◽  
National Healthcare ◽  
Clostridioides Difficile ◽  
Performance Metric ◽  
National Healthcare Safety Network ◽  
Testing Practice

Abstract In total, 13 facilities changed C. difficile testing to reflexive testing by enzyme immunoassay (EIA) only after a positive nucleic acid-amplification test (NAAT); the standardized infection ratio (SIR) decreased by 46% (range, −12% to −71% per hospital). Changing testing practice greatly influenced a performance metric without changing C. difficile infection prevention practice.

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