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Journal of Clinical Microbiology, August 2001, p. 2846-2849, Vol. 39, No. 8
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.8.2846-2849.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Evaluation of Methods for Detection of Toxins in Specimens of Feces Submitted for Diagnosis of Clostridium difficile- Associated Diarrhea

Don O'Connor,1,* Pearl Hynes,2 Martin Cormican,2,3 Edward Collins,2 Geraldine Corbett-Feeney,2,3 and Michael Cassidy1

Microbiology Laboratory, Portiuncula Hospital, Ballinasloe, County Galway,1 and Department of Medical Microbiology, University College Hospital,2 and Department of Bacteriology, National University of Ireland,3 Galway, Ireland

Received 21 February 2001/Returned for modification 18 April 2001/Accepted 4 June 2001

Clostridium difficile is the principal pathogen associated with hospital-acquired acute diarrheal disease. We have evaluated the performances of six approaches for diagnosis of C. difficile-associated diarrhea (CDAD). Consecutive stool specimens (n = 200) from 133 patients were examined by cytotoxin assay, by culture of C. difficile on cycloserine-cefoxitin-fructose agar, and by toxin detection using four rapid immunoassay systems (Oxoid Toxin A test, ImmunoCard Toxin A test, TechLab Tox A/B II test, and Premier Toxins A&B test). A diagnosis of CDAD was established for 35 (27%) patients (representing 29% of specimens). The adjusted sensitivity and specificity of the methods were, respectively, 98 and 99% for the cytotoxin assay, 54 and 99% for ImmunoCard, 50 and 98% for Oxoid, 79 and 98% for TechLab, 80 and 98% for Premier, and 57 and 100% for culture. The TechLab and Premier assays are acceptable tests for diagnosis of CDAD but are not equivalent to the cytotoxin assay.

* Corresponding author. Mailing address: Microbiology Laboratory, Portiuncula Hospital, Ballinasloe, Co. Galway, Ireland. Phone: (353) 0905-48371. Fax: (353) 0905-48363. E-mail: labmanager{at}portiuncula.com.

Journal of Clinical Microbiology, August 2001, p. 2846-2849, Vol. 39, No. 8
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.8.2846-2849.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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