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Journal of Clinical Microbiology, March 2006, p. 1145-1149, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.1145-1149.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Effective Detection of Toxigenic Clostridium difficile by a Two-Step Algorithm Including Tests for Antigen and Cytotoxin

John R. Ticehurst,1,2,3* Deborah Z. Aird,1 Lisa M. Dam,2 Anita P. Borek,1 John T. Hargrove,2 and Karen C. Carroll1,3

Division of Medical Microbiology, Johns Hopkins Hospital,1 Clinical Laboratories, Johns Hopkins Bayview Medical Center,2 Departments of Pathology and Medicine, Johns Hopkins Medicine, Baltimore, Maryland3

Received 20 June 2005/ Returned for modification 12 September 2005/ Accepted 18 November 2005

We evaluated a two-step algorithm for detecting toxigenic Clostridium difficile: an enzyme immunoassay for glutamate dehydrogenase antigen (Ag-EIA) and then, for antigen-positive specimens, a concurrent cell culture cytotoxicity neutralization assay (CCNA). Antigen-negative results were ≥99% predictive of CCNA negativity. Because the Ag-EIA reduced cell culture workload by {approx}75 to 80% and two-step testing was complete in ≤3 days, we decided that this algorithm would be effective. Over 6 months, our laboratories' expenses were US$143,000 less than if CCNA alone had been performed on all 5,887 specimens.

* Corresponding author. Mailing address: Division of Medical Microbiology, The Johns Hopkins Hospital/Meyer B1-193, 600 North Wolfe St., Baltimore, MD 21287-7093. Phone: (410) 955-5077. Fax: (410) 614-8087. E-mail: jticehur{at}jhmi.edu.

Journal of Clinical Microbiology, March 2006, p. 1145-1149, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.1145-1149.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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