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Comparison of four laboratory tests for diagnosis ofClostridium difficile-associated diarrhea

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Abstract

Four different laboratory tests for diagnosis ofClostridium difficile-associated diarrhea were compared to determine the optimal one for management of patients with hospital-acquired diarrhea. Stool samples from 231 patients with diarrhea were tested by the following methods: culture forClostridium difficile with subsequent determination of exotoxin production, with a toxigenicClostridium difficile positive (TCP) result considered truly positive; enzyme immunoassay (EIA); latex agglutination test; and an immunobinding blot assay. The rates of positive results were as follows: EIA 5.5%, TCP 7.3%, latex agglutination 16.7%, and immunobinding blot assay 26.1%. Compared to the TCP results, the sensitivity and specificity were, respectively, 61 and 98% for EIA, 47 and 85% for latex agglutination, and 60 and 76% for the immunobinding blot assay. Samples from patients with ≥ 6 stools/day were TCP and EIA positive in 27 and 17% of cases, respectively, whereas in patients with < 6 stools/day, these percentages decreased to 2 and 3%, respectively (p < 0.001). In hospitalized patients with ≥ 6 stools/day, EIA appears to be the optimal test for diagnosis ofClostridium difficile-associated diarrhea, with a 73% positive predictive value and a 97% negative predictive value. However, in patients with < 6 stools/day, the prevalence ofClostridium difficile is low, and laboratory detection of this organism remains problematic.

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Authors and Affiliations

  1. Department of Geriatrics, Shaare Zedek Medical Center, PO Box 3235, 91031, Jerusalem, Israel

    J. Jacobs, M. Sonnenblick & Y. van Dijk

  2. Clinical Microbiological Laboratory, Shaare Zedek Medical Center, PO Box 3235, 91031, Jerusalem, Israel

    B. Rudensky & A. Berman

  3. Department of Medicine, Shaare Zedek Medical Center, PO Box 3235, 91031, Jerusalem, Israel

    J. Dresner

  4. Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, 91031, Jerusalem, Israel

    A. M. Yinnon

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  1. J. Jacobs
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  2. B. Rudensky
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  3. J. Dresner
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  4. A. Berman
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  5. M. Sonnenblick
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  6. Y. van Dijk
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  7. A. M. Yinnon
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Jacobs, J., Rudensky, B., Dresner, J. et al. Comparison of four laboratory tests for diagnosis ofClostridium difficile-associated diarrhea. Eur. J. Clin. Microbiol. Infect. Dis. 15, 561–566 (1996). https://doi.org/10.1007/BF01709364

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