Comprehensive evaluation of chemiluminescent immunoassays for the laboratory diagnosis of Clostridium difficile infection

Eur J Clin Microbiol Infect Dis. 2017 Jul;36(7):1253-1259. doi: 10.1007/s10096-017-2916-9. Epub 2017 Feb 8.

Abstract

For the microbiological diagnosis of a Clostridium (C.) difficile infection (CDI), a two-test algorithm consisting of a C. difficile glutamate dehydrogenase (GDH)-immunoassay followed by a toxin-immunoassay in positive cases is widely used. In this study, two chemiluminescent immunoassays (CLIAs), one for GDH and the other for the toxins A and B, have been evaluated systematically using appropriate reference methods. Three-hundred diarrhoeal stool specimens submitted for CDI diagnosis were analysed by the LIAISON CLIAs (DiaSorin). Toxigenic culture (TC) and cell cytotoxicity assay (CCTA) were used as "gold standard" reference methods. In addition, GDH and toxin A and B enzyme immunoassays (EIAs), C. diff Chek-60 and toxin A/B II (TechLab), and the Cepheid Xpert C. difficile polymerase chain reaction (PCR) were performed. C. difficile was grown in 42 (14%), TC was positive in 35 (11.7%) and CCTA in 25 (8.3%) cases. CLIAs were more sensitive but less specific than the respective EIAs. Using culture as reference, the sensitivity of the GDH CLIA was 100%. In comparison to CCTA sensitivity, specificity, positive predictive value and negative predictive value of the two-test algorithm were 88, 99.3, 91.7 and 98.9% by CLIAs and 72, 99.6, 94.7 and 97.5% by EIAs. Discrepant results by CLIAs were more frequent than that by EIAs (9% vs. 6.3%); in those cases, PCR allowed for the accurate detection of toxigenic strains. Due to performance characteristics and testing comfort, CLIAs in combination with PCR represent a favourable option for the rapid laboratory C. difficile diagnostics.

Publication types

  • Evaluation Study

MeSH terms

  • ADP Ribose Transferases / analysis
  • ADP Ribose Transferases / immunology
  • Bacterial Proteins / analysis
  • Bacterial Proteins / immunology
  • Clinical Laboratory Techniques / methods*
  • Clostridium Infections / diagnosis*
  • Glutamate Dehydrogenase / analysis
  • Glutamate Dehydrogenase / immunology
  • Humans
  • Immunoassay / methods*
  • Luminescent Measurements*
  • Predictive Value of Tests
  • Sensitivity and Specificity

Substances

  • Bacterial Proteins
  • Glutamate Dehydrogenase
  • ADP Ribose Transferases
  • actin-specific ADP-ribosyltransferase, Clostridium