Year 2016 / Volume 108 / Number 6
Original
Characteristics of Clostridium difficile infection in patients with discordant diagnostic test results

304-308

DOI: 10.17235/reed.2016.4052/2015

Antonio Ramos Martínez, Jorge Ortiz Balbuena, Ángel Asensio Vegas, Isabel Sánchez Romero, Elena Múñez Rubio, Mireia Cantero Caballero, Alberto Cózar Llistó, Francisca Portero Azorín, Rocío Martínez Ruiz,

Abstract
Background: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. Methods: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. Results: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. Conclusions: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.
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Ramos Martínez A, Ortiz Balbuena J, Asensio Vegas Á, Sánchez Romero I, Múñez Rubio E, Cantero Caballero M, et all. Characteristics of Clostridium difficile infection in patients with discordant diagnostic test results. 4052/2015


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Publication history

Received: 16/10/2015

Accepted: 25/03/2016

Online First: 01/04/2016

Published: 03/06/2016

Article revision time: 129 days

Article Online First time: 168 days

Article editing time: 231 days


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