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Journal of Clinical Microbiology, May 2001, p. 1855-1858, Vol. 39, No. 5
Departments of Laboratory Medicine1
and Internal Medicine,3 Yale University
School of Medicine, New Haven, Connecticut 06520; Clinical
Virology Laboratory2 and Department of
Quality Improvement and Support Services,4 Yale
New Haven Hospital, New Haven, Connecticut 06504; and
Department of Internal Medicine; University of California
Davis, Sacramento, California 958175
Received 5 September 2000/Returned for modification 2 January
2001/Accepted 22 February 2001
One hundred two stool samples were tested by both the rapid Triage
Clostridium difficile Panel (Triage Panel) and the
cytotoxin cell culture assay. Five samples positive by both the
C. difficile toxin A (Tox A) and common antigen components
of the Triage Panel had cytotoxin titers of
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.5.1855-1858.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
Evaluation of Biosite Triage Clostridium
difficile Panel for Rapid Detection of Clostridium
difficile in Stool Samples
10,000. Twenty-three
samples were Triage Panel Tox A negative but common antigen positive.
Ten of these had cytotoxin titers of 10 to 1,000, but 13 were cytotoxin
negative. Bacterial isolates obtained from 8 of these 13 specimens were analyzed for Tox A and B genes by PCR, and only two contained toxigenic
bacteria. Thus, the majority of samples positive only for C. difficile common antigen contained nontoxigenic bacteria. A
Triage Panel Tox A-positive result indicated a
sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) of 33.3, 100, 100, and 88.2%,
respectively. A Triage Panel common antigen-positive result indicated a
sensitivity, specificity, PPV, and NPV of 100, 82.7, 53.6, and
100%, respectively. The high NPV of the Triage Panel common antigen,
together with rapid reporting of results, should prove useful in
avoiding unnecessary use of contact precautions and antibiotic
treatment for C. difficile-negative patients. However, with
Triage Panel common antigen-positive patients, a sensitive
cytotoxin assay should be used to distinguish true cytotoxin-positive
patients from C. difficile carriers.
*
Corresponding author. Mailing address: Department of
Laboratory Medicine, Yale University School of Medicine, P.O. Box
208035, New Haven, CT 06520-8035. Phone: (203) 688-3475. Fax: (203)
688-8177. E-mail: marie.landry{at}yale.edu.
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