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Medline ® Abstract for Reference 60

of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'

Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin.
Ticehurst JR, Aird DZ, Dam LM, Borek AP, Hargrove JT, Carroll KC
J Clin Microbiol. 2006;44(3):1145.
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>or = 99% predictive of CCNA negativity. Because the Ag-EIA reduced cell culture workload by approximately 75 to 80% and two-step testing was complete in<or = 3 days, we decided that this algorithm would be effective. Over 6 months, our laboratories' expenses were US dollar 143,000 less than if CCNA alone had been performed on all 5,887 specimens.
Division of Medical Microbiology, The Johns Hopkins Hospital/Meyer B1-193, 600 North Wolfe St., Baltimore, Maryland 21287-7093, USA. jticehur@jhmi.edu