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Would Real-Time PCR Methods For The Detection Of Toxigenic C. Difficile Infection Have Increased Sensitivity In Comparison With Eias?



Would Real-Time PCR Methods For The Detection Of Toxigenic C. Difficile Infection Have Increased Sensitivity In Comparison With Eias

Introduction

Clostridium di?cile-associated diarrhea (CDAD) is the most common etiologically de?ned cause of hospital-acquired diarrhea. Caused by the toxins of certain strains of C di?cile, CDAD represents a growing concern, with epidemic outbreaks in some hospitals where very aggressive and di?cult-to-treat strains have been found recently [1-9]. Incidence of CDAD varies ordinarily between 1 and 10 cases in every 1,000 admissions, raising rates of morbidity and signi?cantly increasing costs [10,11]. Length of stay of in-patients with CDAD is prolonged from 18 to 30 days[12,13] and the disease has an estimated extra cost per episode for the hospital budget of £4,107, as calculated by a British group, and $3,340, as calculated by a group in the United States. lostridium difficile toxin tests are used to diagnose antibiotic-associated diarrhea and other conditions and complications caused by toxin-producing C. difficile. Conditions resulting from this infection include pseudomembranous colitis, in which dead tissue, fibrous protein, and numerous white blood cells form a lining over the surface of the inflamed bowel, toxic megacolon, and perforated bowel. Testing may also be ordered to detect recurrent disease.

Clostridium difficile is a gram-positive anaerobic bacillus responsible for approximately 1 of 5 cases of antibiotic-associated diarrhea. C difficile infection (CDI) is defined by at least 3 unformed stools in a 24-hour period and stool, endoscopic, or histopathologic test results that indicate the presence of this bacteria. The history of CDI research can be divided into early (before 2000) and modern eras (after 2000). C difficile was first described in 1935, and the characteristics and causes of CDI as well as therapies were identified during the early era of research. During the modern era, CDI has become a more common, aggressive nosocomial infection. Our understanding of the epidemiology, diagnosis, treatment, and prevention of CDI has increased at a rapid pace. We review features of CDI diagnosis, treatment, and prevention.

There are a number of tests that are available to detect the infection and to determine if the strain that is present produces toxin. Some tests are very sensitive but take some days to complete, while other tests are rapid (several hours) but are not considered to be very sensitive or specific.

Discussion

Clostridium difficile infection (CDI) is a costly health care-associated disease,[1] which seems to be increasing in virulence[2,3] and incidence[4-6] and worsening in response to traditionally accepted metronidazole therapy.[7] CDI is caused by toxigenic C difficile that usually produces 2 major toxins, toxin A, an enterotoxin, and toxin B, a potent cytotoxin.[8-12] Recently, it has been shown that toxin B is the main virulence factor for disease. The clinical standard for suspecting CDI is significant diarrhea, defined as 3 or more loose stools per day[14] for 1 to 2 days.[15] Because there is no assay for the actual determination of C difficile infection, the role ...