Año 2016 / Volumen 108 / Número 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,

Resumen
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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Ficha Técnica

Recibido: 16/10/2015

Aceptado: 25/03/2016

Prepublicado: 01/04/2016

Publicado: 03/06/2016

Tiempo de revisión del artículo: 129 días

Tiempo de prepublicación: 168 días

Tiempo de edición del artículo: 231 días


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