Evaluation of the performance of C. DIFF QUIK CHEK COMPLETE and its usefulness in a hospital setting with a high prevalence of Clostridium difficile infection

2016 ◽  
Vol 65 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Hae-Sun Chung ◽  
Miae Lee
Keyword(s):  
Clostridium Difficile ◽  
Hospital Setting ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Confirmatory Test ◽  
Laboratory Diagnostics ◽  
Initial Screening ◽  
Toxin A ◽  
Predictive Values ◽  
High Prevalence

Rapid and accurate diagnosis of Clostridium difficile infection (CDI) is crucial for patient care, infection control, and efficient surveillance. We evaluated C. DIFF QUIK CHEK COMPLETE (QCC; TechLab), which detects glutamate dehydrogenase (GDH) antigen (QCC-Ag) and toxin A/B (QCC-Tox) simultaneously, and compared it to the laboratory diagnostics for CDI currently in use in a tertiary hospital setting with a high prevalence of CDI. QCC, RIDASCREEN C. difficile toxin A/B assay (Toxin EIA; R-Biopharm AG), chromID C. difficile agar (bioMérieux) culture (ChromID culture), and Xpert C. difficile PCR assay (Xpert PCR; Cepheid) were performed according to the manufacturers' instructions. Performances of the assays were compared against that of Xpert PCR as a reference. Of the 231 loose stool specimens, 83 (35.9%) were positive by Xpert PCR. The sensitivity, specificity, and positive and negative predictive values were 97.6%, 93.9%, 90.0%, and 98.6%, respectively, for QCC-Ag and 55.4%, 100%, 100%, and 80.0%, respectively, for QCC-Tox. The median threshold cycle values of the QCC-Tox(+) specimens were lower than those of the QCC-Tox(−) specimens. Results of QCC as an initial screening test were confirmed in 81.0% (187/231) of samples; these specimens did not require further testing. QCC is a rapid, easy, and cost-effective method that would be a useful first-line screening assay for laboratory diagnosis of CDI in a tertiary hospital with a high prevalence of CDI. A two-step algorithm using QCC as an initial screening tool, followed by Xpert PCR as a confirmatory test, is a practical and cost-effective approach.

scholarly journals High Prevalence of Extended-Spectrum β-Lactamase-Producing Strains among Blood Isolates of Enterobacter spp. Collected in a Tertiary Hospital during an 8-Year Period and Their Antimicrobial Susceptibility Patterns

2004 ◽  
Vol 48 (8) ◽  
pp. 3159-3161 ◽  
Author(s):  
Hyunjoo Pai ◽  
Jung Yun Hong ◽  
Jeong-Hum Byeon ◽  
Yun-Kyung Kim ◽  
Hoan-Jong Lee
Keyword(s):  
Production Rate ◽  
Antimicrobial Susceptibility ◽  
Tertiary Hospital ◽  
Confirmatory Test ◽  
Esbl Production ◽  
Extended Spectrum ◽  
High Prevalence ◽  
Resistant Strains ◽  
Susceptibility Patterns

ABSTRACT Of 72 blood isolates of Enterobacter spp. collected over an 8-year period, 50% (36 of 72) were derepressed or partially derepressed AmpC mutants. The extended-spectrum β-lactamase (ESBL) production rate was 43% (31 of 72 isolates), and 67.3% (31 of 46) of extended-spectrum cephalosporin-resistant strains produced ESBLs. Thus, a confirmatory test for ESBL production is necessary for extended-spectrum cephalosporin-resistant Enterobacter spp.

High prevalence of toxin a-negative, toxin b-positive clostridium difficile in Dublin, Ireland

Endoscopy ◽  
2006 ◽  
Vol 37 (12) ◽  
Author(s):  
D Drudy ◽  
N Harnedy ◽  
S Fanning ◽  
R O'Mahony ◽  
A Baird ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Toxin A ◽  
Toxin B ◽  
High Prevalence

Carpal Tunnel Syndrome – Is High-Frequency Ultrasound a Useful Diagnostic Tool?

2003 ◽  
Vol 28 (1) ◽  
pp. 77-79 ◽  
Author(s):  
L. LEONARD ◽  
A. RANGAN ◽  
G. DOYLE ◽  
G. TAYLOR
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Hospital Setting ◽  
Confirmatory Test ◽  
High Frequency Ultrasound ◽  
Cross Sectional ◽  
Predictive Values ◽  
Epidemiological Surveys ◽  
Tunnel Syndrome

This study assessed the clinical use of three ultrasound measurements; median nerve cross-sectional area, median nerve flattening ratio and palmar displacement of the flexor retinaculum, for the diagnosis of carpal tunnel syndrome. The measurements were made in 20 carpal tunnel sufferers and 20 controls. The sensitivity, specificity and predictive values of each were calculated in various clinical settings. Values for each of the three variables were significantly different in the patient and control populations. The differences we recorded were smaller than those found in previous studies. The tests had a sensitivity of 72% and a specificity of 90%. Alterations in the morphology of the carpal tunnel in patients with carpal tunnel syndrome can be measured in the district general hospital setting. The measurements described maybe a useful non-invasive confirmatory test in patients in whom there is a strong clinical suspicion of carpal tunnel syndrome. However, they would be of no benefit in epidemiological surveys of populations with a low incidence of carpal tunnel syndrome.

scholarly journals Comparison of the Premier Toxin A and B Assay and the TOX A/B II Assay for Diagnosis of Clostridium difficile Infection

2008 ◽  
Vol 15 (3) ◽  
pp. 575-578 ◽  
Author(s):  
Susan M. Novak-Weekley ◽  
Michele H. Hollingsworth
Keyword(s):  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Toxin A ◽  
Kaiser Permanente ◽  
Toxin B ◽  
Predictive Values ◽  
Nosocomial Diarrhea ◽  
Stool Specimens ◽  
Higher Sensitivity ◽  
Regional Reference

ABSTRACT Clostridium difficile causes nosocomial diarrhea and is responsible for complications such as pseudomembranous colitis, megacolon, and perforation. Using 442 stool specimens, we compared the sensitivities and specificities of the Premier toxin A and B (Meridian Bioscience, Inc.) and C. difficile TOX A/B II (TechLab, Inc., Blacksburg, VA) immunoassays in the Virology Department of the Kaiser Permanente Regional Reference Laboratories. The Premier toxin A and B assay demonstrated a higher sensitivity (97.44%) and a higher positive predictive value (79.17%) than the C. difficile TOX A/B II assay (87.18% and 75.56%, respectively), while assay specificities and negative predictive values were similar. We also performed experiments using serially diluted, purified toxin A and B antigens to understand the basis for assay differences. The two assays’ toxin A antibodies detected toxin A at comparable levels. Preliminary results indicated that the toxin B antibody in the Premier toxin A and B assay could detect toxin B at a concentration of 125 pg/100 μl, while the toxin B antibody in the C. difficile TOX A/B II assay could not detect toxin B below a concentration of 250 pg/100 μl. Therefore, the Premier toxin A and B assay provides greater sensitivity than the C. difficile TOX A/B II assay, perhaps due to a superior detection ability of its toxin B antibody.

scholarly journals Molecular epidemiology of Clostridium difficile in a tertiary hospital of China

2014 ◽  
Vol 63 (4) ◽  
pp. 562-569 ◽  
Author(s):  
Yun-Bo Chen ◽  
Si-Lan Gu ◽  
Ze-Qing Wei ◽  
Ping Shen ◽  
Hai-Sheng Kong ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Molecular Epidemiology ◽  
Epidemiological Data ◽  
Type A ◽  
Tertiary Hospital ◽  
Gene Profiling ◽  
Toxin Gene ◽  
Toxin A ◽  
Toxigenic Strains ◽  
Clade 1

Clostridium difficile infection (CDI) is caused by toxin-producing strains. It accounts for 20–30 % of antibiotic-associated diarrhoea and particularly accounts for 90 % of pseudomembranous colitis. The epidemiological study of C. difficile is thus important. In this study, we report the molecular epidemiology and ward distribution of C. difficile in a tertiary hospital of China. A total of 161 toxigenic strains were isolated from 1845 patients originating from different wards and the strains were characterized based on toxin profile and multilocus sequence typing. Variable isolation rates were observed in different wards and the occurrence was higher in intensive care unit and geriatric wards. Toxin gene profiling revealed that, out of the 161 isolates, 134 (83.2)% were positive for both toxin A (tcdA) and toxin B (tcdB) (A+B+) followed by toxin A-negative and B-positive (A−B+) (16.8 %) isolates. However, only three of the toxigenic strains (1.9 %) were positive for both the cdtA and cdtB genes. Based on the molecular epidemiology study, a total of 30 different sequence types (STs), including one new ST (ST-220), were distinguishable. ST-54 was the most prevalent (23.0 %), followed by ST-35 (19.3 %) and ST-37 (10.0 %). None of the isolates belonged to ST-1 (ribotype 027) or ST-11 (ribotype 078). Taken together, the toxin profile and the molecular epidemiological data showed that all the ST-37 clades were of toxin type A−B+, which accounted for 59.3 % of all type A−B+ isolates. Meanwhile the clade 1 genotype, ST-54, was widely distributed among the geriatric, infection and haematology wards. There was no outbreak of C. difficile infection during our study; however the possibility of prolonged outbreaks cannot be completely ignored.

scholarly journals Predictors of Sleep Disorders among HIV Out-Patients in a Tertiary Hospital

2017 ◽  
Vol 03 ◽  
pp. 103
Author(s):  
Elvis Mbu Bisong ◽  
Uduak Effiong Williams ◽  
Henry Ohem Okpa ◽  
Ofem Egbe Enang ◽  
Emmanuel Monjok ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Sleep Disorder ◽  
Highly Active Antiretroviral Therapy ◽  
Prevalence Rate ◽  
Sleep Disturbances ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Antiretroviral Drugs ◽  
Elevated Systolic Blood Pressure ◽  
High Prevalence

Human immunodeficiency virus (HIV)-infected individuals have been shown to have a high prevalence of sleep disturbances. Both the effects of the virus and the antiretroviral drugs may cause sleep disturbances. We sought to determine the prevalence and predictors of sleep disorders among HIV seropositive adult subjects presenting at an outpatient hospital setting. One hundred and fifty six subjects were recruited for the study by using a sleep disorder screening questionnaire. The mean ages of the participants were 38.7 ± 9.23 and 39.5 ± 9.23 for those with and those without sleep disorder, respectively. The prevalence rate of sleep disorders was 46.2%. Elevated systolic blood pressure, lower CD4 count levels, and being on the highly active antiretroviral therapy combination TDF/3TC/ATZ/lpvr were associated with sleep disorders. The high prevalence rate observed necessitates routine screening for sleep disorders among HIV/AIDs patients.

Highly Effective Model for Implementation of In-House Platelets in a Tertiary Hospital Setting Without a Trauma Center: Corporal Michael J. Crescenz Veterans Affairs Medical Center (CMCVAMC) Experience

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S154-S155
Author(s):  
Vijal Patel ◽  
Jeffrey Petersen ◽  
Darshana Jhala
Keyword(s):  
Trauma Center ◽  
Medical Center ◽  
Hospital Setting ◽  
Cost Savings ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Effective Model ◽  
System Model ◽  
Effective Measure ◽  
Highly Effective

Abstract Introduction Platelet products have a limited shelf life and are costly. Hence, it remains crucial to balance clinical usage and wastage in a tertiary hospital setting without a trauma center. Considering this, an innovative system model was established to reduce wastage: the CMCVAMC—starting October 2017—arranged to transfer the platelet unit to a nearby facility with a trauma center when product has a short expiration date and there is no anticipated need for the product. This is a cost-effective measure to reduce platelet wastage and ensure the appropriate blood product availability. Method QA/QI data were reviewed to determine the degree of platelet wastage both a year prior to the implementation of this platelet transfer to another facility and after the past implementation of this transfer to February 2019. The cost of each platelet product was determined from the blood supplier (American Red Cross). From these comparisons prior to and after implementation, a determination of reduction of product wastage and cost savings was made. Results Since the implementation of this platelet transfer, there have been no platelets expiring on the shelf. In contrast, from October 2016 to October 2017 prior to implementation of platelet transfer, platelet products were often wasted or expired. In contrast, from October 2017 to February 2019, there has been no wastage of platelets. Conclusion This is a highly effective model for a tertiary hospital without a trauma center to bring in house platelets without wastage of a costly product while maintaining appropriate availability of the product. This quality improvement system study demonstrates that the measure resulted in significant savings and this serves as a model for other similar facilities. This is an innovative, easy to implement, and cost-effective system model that can be used in other tertiary facilities without a trauma center.

scholarly journals Comparative Study of Clostridium difficile Clinical Detection Methods in Patients with Diarrhoea

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yanyan Xiao ◽  
Yong Liu ◽  
Xiaosong Qin
Keyword(s):  
Clostridium Difficile ◽  
Detection Methods ◽  
Binary Toxin ◽  
Toxin Gene ◽  
Initial Screening ◽  
Pcr Assay ◽  
Toxin A ◽  
Quick Method ◽  
Toxigenic Culture ◽  
Clinical Detection

Objectives. The aim of this study was to evaluate the clinical application of three methods for detecting Clostridium difficile in fecal samples. Methods. One hundred and fifty fecal specimens were collected and tested for C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. Results. Of 150 specimens, 26 carried both A and B toxin genes, and none of the samples were positive for the binary toxin gene. Toxin-producing C. difficile was found in 17.3% (26/150) of the samples. Thirty-seven GDH-positive samples were detected using the VIDAS GDH assay, and 15 toxin-positive samples were detected using the VIDAS toxin A/B assay. The GeneXpert PCR assay was used to detect C. difficile in 79 specimens simultaneously, and a total of 18 positive specimens were detected. Conclusion. The VIDAS GDH assay is useful for initial screening of C. difficile. The GeneXpert PCR assay is a simple and quick method.

scholarly journals Prevalence of anemia in pediatric patients of traumatic brain injury and problems associated with management in a developing country: Unfolding of an underrated comorbidity

2021 ◽  
Vol 12 ◽  
pp. 75
Author(s):  
Mohammad Ashraf ◽  
Usman Ahmad Kamboh ◽  
Mohammad Zubair ◽  
Kashif Ali Sultan ◽  
Muhammad Asif Raza ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Common Knowledge ◽  
Demographic Data ◽  
Hospital Setting ◽  
Case Series ◽  
Tertiary Hospital ◽  
High Prevalence ◽  
Prevalence Of Anemia

Background: Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view. Methods: A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital’s pediatrics’ anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented. Results: The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic. Conclusion: Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.

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