Correlation Between Fecal Toxin Enzyme Immunoassays and Disease Severity in Patients with Clostridioides difficile Infection in a Korean University Hospital
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: The aim of this study was to evaluate the clinical usefulness of the Clostridioides difficile toxin enzyme immunoassay (EIA) and nucleic acid amplification test (NAAT) in determining the severity of C. difficile infection (CDI) according to three different severity criteria: the ATLAS score of Miller et al., the CDAD severity score of Zar FA et al., and the CDSS score of Na et al. Methods: From December 2015 to May 2018, 91 patients suspected of suffering from antibiotic-related diarrhea among those who tested positive (including equivocal) in either fecal C. difficile toxin EIA (VIDAS toxin A/B enzyme-linked fluorescent assay, BioMerieux SA, France) or NAAT (Seeplex Diarrhea ACE kit, Seegene, Korea), or both were tested to investigate the correlation between the results of each assay and the severity of CDI via retrospective medical record review and statistical testing. Results: For the 88 C. difficile tcdB NAAT positive cases, EIA positivity significantly correlated with the ATLAS score (P =0.005) but did not correlate with the CDAD severity (P =0.107) and CDSS scores (P =0.534). When EIA equivocal results were considered to be positive results, EIA positivity correlated with the CDAD severity (P =0.03) and ATLAS scores (P <0.001) but did not correlate with the CDSS score (P =0.169). Conclusions: The C. difficile toxin EIA assay may be clinically useful in assessing the severity of disease in CDI patients, especially in correlation with ATLAS severity scores.
Abstract
Background: The aim of this study was to evaluate the clinical usefulness of the Clostridioides difficile toxin enzyme immunoassay (EIA) and nucleic acid amplification test (NAAT) in determining the severity of C. difficile infection (CDI) according to three different severity criteria: the ATLAS score of Miller et al., the CDAD severity score of Zar FA et al., and the CDSS score of Na et al. Methods: From December 2015 to May 2018, 91 patients suspected of suffering from antibiotic-related diarrhea among those who tested positive (including equivocal) in either fecal C. difficile toxin EIA (VIDAS toxin A/B enzyme-linked fluorescent assay, BioMerieux SA, France) or NAAT (Seeplex Diarrhea ACE kit, Seegene, Korea), or both were tested to investigate the correlation between the results of each assay and the severity of CDI via retrospective medical record review and statistical testing. Results: For the 88 C. difficile tcdB NAAT positive cases, EIA positivity significantly correlated with the ATLAS score (P =0.005) but did not correlate with the CDAD severity (P =0.107) and CDSS scores (P =0.534). When EIA equivocal results were considered to be positive results, EIA positivity correlated with the CDAD severity (P =0.03) and ATLAS scores (P <0.001) but did not correlate with the CDSS score (P =0.169). Conclusions: The C. difficile toxin EIA assay may be clinically useful in assessing the severity of disease in CDI patients, especially in correlation with ATLAS severity scores.
참고문헌 (33)
- Vedantam G, "Clostridium difficile infection : toxins and non-toxin virulence factors, and their contributions to disease establishment and host response", Gut Microbes, 3, pp.121~134 (2012)
- Desai K, "Epidemiological and economic burden of Clostridium difficile in the United States : estimates from a modeling approach", BMC Infect Dis, 16, pp.303~ (2016)
- Borren NZ, "The emergence of Clostridium difficile infection in Asia : a systematic review and meta-analysis of incidence and impact", PLoS One, 12, pp.e0176797~ (2017)
- Gateau C, "How to : diagnose infection caused by Clostridium difficile", Clin Microbiol Infect, 24, pp.463~468 (2018)
- Debast SB, "European Society of Clinical Microbiology and Infectious Diseases : update of the treatment guidance document for Clostridium difficile infection", Clin Microbiol Infect, 20(Suppl 2), pp.1~26 (2014)
- McDonald LC, "Clinical practice guidelines for Clostridium difficile infection in adults and children : 2017 Update by the Infectious Diseases Society of America(IDSA)and Society for Healthcare Epidemiology of America(SHEA)", Clin Infect Dis, 66, pp.e1~e48 (2018)
- Peng Z, "Advances in the diagnosis and treatment of Clostridium difficile infections", Emerg Microbes Infect, 7, pp.15~ (2018)
- George WL, "Selective and differential medium for isolation of Clostridium difficile", J Clin Microbiol, 9, pp.214~219 (1979)
- Chang TW, "Neutralization of Clostridium difficile toxin by Clostridium sordellii antitoxins", Infect Immun, 22, pp.418~422 (1978)
- Lyerly DM, "Enzyme-linked immunosorbent assay for Clostridium difficile toxin A", J Clin Microbiol, 17, pp.72~78 (1983)
- Kato N, "Detection of toxigenic Clostridium difficile in stool specimens by the polymerase chain reaction", J Infect Dis, 167, pp.455~458 (1993)
- Gerding DN, "Diagnosis and Treatment of Clostridium difficile Infection (CDI)", Infect Dis Clin Pract (Baltim Md), 24, pp.3~10 (2016)
- Carroll KC, "Biology of Clostridium difficile : implications for epidemiology and diagnosis", Annu Rev Microbiol, 65, pp.501~521 (2011)
- Kukla M, "Guidelines for Clostridium difficile infection in adults", Prz Gastroenterol, 15, pp.1~21 (2020)
- Lungulescu OA, "CSI : a severity index for Clostridium difficile infection at the time of admission", J Hosp Infect, 79, pp.151~154 (2011)
- Bauer MP, "Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis", Clin Infect Dis, 55(Suppl 2), pp.S149~S153 (2012)
- Zar FA, "A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity", Clin Infect Dis, 45, pp.302~307 (2007)
- Miller MA, "Derivation and validation of a simple clinical bedside score(ATLAS)for Clostridium difficile infection which predicts response to therapy", BMC Infect Dis, 13, pp.148~ (2013)
- Na X, "A multicenter prospective derivation and validation of a clinical prediction tool for severe Clostridium difficile infection", PLoS One, 10, pp.e0123405~ (2015)
- Crobach MJ, "European Society of Clinical Microbiology and Infectious Diseases : update of the diagnostic guidance document for Clostridium difficile infection", Clin Microbiol Infect, 22(Suppl 4), pp.S63~S81 (2016)
- Eastwood K, "Comparison of nine commercially available Clostridium difficile toxin detection assays, a realtime PCR assay for C. difficile tcdB, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods", J Clin Microbiol, 47, pp.3211~3217 (2009)
- Hernández-Rocha C, "Prospective comparison of a commercial multiplex real-time polymerase chain reaction and an enzyme immunoassay with toxigenic culture in the diagnosis of Clostridium difficile-associated infections", Diagn Microbiol Infect Dis, 75, pp.361~365 (2013)
- Zimmermann S, "Work ow optimization for syndromic diarrhea diagnosis using the molecular Seegene Allplex™ GI-Bacteria(I)assay", Eur J Clin Microbiol Infect Dis, 39, pp.1245~1250 (2020)
- Coupland LJ, "Simultaneous detection of viral and bacterial enteric pathogens using the Seeplex® Diarrhea ACE detection system", Epidemiol Infect, 141, pp.2111~2121 (2013)
- Onori M, "Evaluation of a multiplex PCR assay for simultaneous detection of bacterial and viral enteropathogens in stool samples of paediatric patients", Diagn Microbiol Infect Dis, 79, pp.149~154 (2014)
- Shin BM, "Comparison of BD GeneOhm Cdiff and Seegene Seeplex ACE PCR assays using toxigenic Clostridium difficile culture for direct detection of tcdB from stool specimens", J Clin Microbiol, 50, pp.3765~3767 (2012)
- Cohen NA, "Clostridium difficile fecal toxin level is associated with disease severity and prognosis", United European Gastroenterol J, 6, pp.773~780 (2018)
- Planche TD, "Differences in outcome according to Clostridium difficile testing method : a prospective multicentre diagnostic validation study of C. difficile infection", Lancet Infect Dis, 13, pp.936~945 (2013)
- Humphries RM, "Performance of Clostridium difficile toxin enzyme immunoassay and nucleic acid amplification tests stratified by patient disease severity", J Clin Microbiol, 51, pp.869~873 (2013)
- Polage CR, "Overdiagnosis of Clostridium difficile infection in the molecular test era", JAMA Intern Med, 175, pp.1792~1801 (2015)
- Kumar S, "Diagnosis and outcome of Clostridium difficile infection by toxin enzyme immunoassay and polymerase chain reaction in an island population", J Gastroenterol Hepatol, 32, pp.415~419 (2017)
- Kamboj M, "Potential of real-time PCR threshold cycle(CT)to predict presence of free toxin and clinically relevant C. difficile infection(CDI)in patients with cancer", J Infect, 76, pp.369~375 (2018)
- Kim YJ, "Prevalence of Clostridium perfringens toxin in patients suspected of having antibiotic-associated diarrhea", Anaerobe, 48, pp.34~36 (2017)