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Current knowledge on the laboratory diagnosis of Clostridium difficile infection

World Journal of Gastroenterology 2017年第9期23卷 1552-1567页

作者： Adrián Martínez-Meléndez Adrián Camacho-Ortiz Rayo Morfin-Otero Héctor Jesús Maldonado-Garza Licet Villarreal-Trevino Elvira Garza-González Departamento de Microbiología e Inmunología Facultad de Ciencias BiológicasUniversidad Autónoma de Nuevo León.Pedro de Alba S/NCiudad UniversitariaSan Nicolás de los Garza Servicio de Infectología Hospital Universitario“Dr.JoséEleuterio González”Universidad Autónoma de Nuevo León.Av.Francisco I.Madero Pte.S/NCol.Mitras Centro.Monterrey Hospital Civil de Guadalajara “Fray Antonio Alcalde”e Instituto de Patología Infecciosa y ExperimentalCentro Universitario de Ciencias de la SaludUniversidadde Guadalajara.Sierra Mojada 950Col.Independencia Servicio de Gastroenterología Hospital Universitario“Dr.JoséEleuterio González”Universidad Autónoma de Nuevo León.Av.Francisco I.Madero Pte.S/NCol.Mitras Centro.Monterrey

Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from selflimited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Due to extensive antibiotic usage, the number of CDIs has increased. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with the disease, mainly with regards to antibiotic management. The diagnosis of CDI is primarily based on the clinical signs and symptoms and is only confirmed by laboratory testing. Despite the high burden of CDI and the increasing interest in the disease, episodes of CDI are often misdiagnosed. The reasons for misdiagnosis are the lack of clinical suspicion or the use of inappropriate tests. The proper diagnosis of CDI reduces transmission, prevents inadequate or unnecessary treatments, and assures best antibiotic treatment. We review the options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention of CDI.

关键词： Clostridium difficile toxigenic culture Nucleic acid amplification tests Enzyme immunoassay Diagnosis Glutamate dehydrogenase

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