Evaluation of the Cepheid Xpert Clostridium difficile Epi Assay for Diagnosis of Clostridium difficile Infection and Typing of the NAP1 Strain at a Cancer Hospital

Clostridium difficile is the most common cause of health care-associated diarrhea. Accurate and rapid diagnosis is essential to improve patient outcome and prevent disease spread. We compared our two-step diagnostic algorithm, an enzyme immunoassay for glutamate dehydrogenase (GDH) followed by the c...

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Published in:Journal of Clinical Microbiology 2010-12, Vol.48 (12), p.4519-4524
Main Authors: Babady, N. Esther, Stiles, Jeffrey, Ruggiero, Phyllis, Khosa, Perminder, Huang, David, Shuptar, Susan, Kamboj, Mini, Kiehn, Timothy E
Format: Article
Language:English
Subjects:
Bacterial Proteins - genetics
Bacteriological Techniques - methods
Bacteriology
Biological and medical sciences
Cancer Care Facilities
Clostridium difficile
Clostridium difficile - classification
Clostridium difficile - isolation & purification
Clostridium Infections - diagnosis
Clostridium Infections - microbiology
Cross Infection - diagnosis
Cross Infection - microbiology
Enzyme-Linked Immunosorbent Assay - methods
Feces - microbiology
Fundamental and applied biological sciences. Psychology
Genotype
Humans
Medical sciences
Microbiology
Miscellaneous
Polymerase Chain Reaction - methods
Repressor Proteins - genetics
Ribotyping
Sensitivity and Specificity
Tumors
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Stiles, Jeffrey
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Kamboj, Mini
Kiehn, Timothy E
description Clostridium difficile is the most common cause of health care-associated diarrhea. Accurate and rapid diagnosis is essential to improve patient outcome and prevent disease spread. We compared our two-step diagnostic algorithm, an enzyme immunoassay for glutamate dehydrogenase (GDH) followed by the cytotoxin neutralization test (CYT) with a turnaround time of 24 to 48 h, versus the Cepheid Xpert C. difficile Epi assay, a PCR-based assay with a turnaround time of 90%). The excellent sensitivity and specificity and the rapid turnaround time of the Xpert PCR assay as well as its strain-typing capability make it an attractive option for diagnosis of C. difficile infection.
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In the second phase, all stool samples were tested by GDH and Xpert PCR. Only GDH-positive stools were further tested by CYT. Genotypic characterization of 45 Xpert PCR-positive stools was performed by sequencing of the tcdC gene and PCR ribotyping. In phase 1, the agreement between the GDH-CYT and the GDH-Xpert PCR was 72%. The sensitivities and specificities of GDH-CYT and GDH-Xpert PCR were 57% and 97% and 100% and 97%, respectively. In phase 2, the agreement between GDH-CYT and Xpert PCR alone was 95%. As in phase 1, sensitivity of the Xpert PCR was higher than that of the GDH-CYT. The correlation between PCR-ribotyping, sequencing, and Xpert PCR for detection of NAP1 strains was excellent (&gt;90%). 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As in phase 1, sensitivity of the Xpert PCR was higher than that of the GDH-CYT. The correlation between PCR-ribotyping, sequencing, and Xpert PCR for detection of NAP1 strains was excellent (&gt;90%). The excellent sensitivity and specificity and the rapid turnaround time of the Xpert PCR assay as well as its strain-typing capability make it an attractive option for diagnosis of C. difficile infection.</abstract><cop>Washington, DC</cop><pub>American Society for Microbiology</pub><pmid>20943860</pmid><doi>10.1128/JCM.01648-10</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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source PubMed Central (Open Access); American Society for Microbiology Journals
subjects Bacterial Proteins - genetics
Bacteriological Techniques - methods
Bacteriology
Biological and medical sciences
Cancer Care Facilities
Clostridium difficile
Clostridium difficile - classification
Clostridium difficile - isolation & purification
Clostridium Infections - diagnosis
Clostridium Infections - microbiology
Cross Infection - diagnosis
Cross Infection - microbiology
Enzyme-Linked Immunosorbent Assay - methods
Feces - microbiology
Fundamental and applied biological sciences. Psychology
Genotype
Humans
Medical sciences
Microbiology
Miscellaneous
Polymerase Chain Reaction - methods
Repressor Proteins - genetics
Ribotyping
Sensitivity and Specificity
Tumors
title Evaluation of the Cepheid Xpert Clostridium difficile Epi Assay for Diagnosis of Clostridium difficile Infection and Typing of the NAP1 Strain at a Cancer Hospital
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