M.H. Wilcox Clinical Microbiology and Infection

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Presentation transcript:

Overcoming barriers to effective recognition and diagnosis of Clostridium difficile infection M.H. Wilcox Clinical Microbiology and Infection Volume 18, Pages 13-20 (January 2012) DOI: 10.1111/1469-0691.12057 Copyright © 2012 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

FIG. 1 Correlation between the frequency of Clostridium difficile infection (CDI) testing and measured CDI incidence [4]. Clinical Microbiology and Infection 2012 18, 13-20DOI: (10.1111/1469-0691.12057) Copyright © 2012 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

FIG. 2 Two-step diagnostic algorithm for Clostridium difficile infection (CDI) as recommended by the European Society of Clinical Microbiology and Infectious Diseases [1]. EIA, enzyme immunoassay; GDH, glutamate dehydrogenase; TcdA, C. difficile toxin A; TcdB, C. difficile toxin B. *A positive toxinogenic culture always indicates the presence of toxin-producing C. difficile and makes further testing unnecessary. Reproduced with permission from Crobach MJT et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect 2009; 15: 1053-1066. ©2009 The Authors. ©2009 European Society of Clinical Microbiology and Infectious Diseases. Clinical Microbiology and Infection 2012 18, 13-20DOI: (10.1111/1469-0691.12057) Copyright © 2012 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

FIG. 3 Two-step diagnostic algorithm for Clostridium difficile infection (CDI) in a patient with unexplained diarrhoea (Bristol Stool Chart types 5-7) [34]. EIA, enzyme immunoassay; GDH, glutamate dehydrogenase; NAAT, nucleic acid amplification test. SIGHT: S = suspect that a case may be infective when there is no clear alternative cause for diarrhoea; I = isolate the patient within 2 h; G = gloves and aprons must be used for all contacts with the patient and their environment; H = hand-washing with soap and water should be carried out before and after each contact with the patient and the patient's environment; T = test the stool for C. difficile by sending specimen immediately. *Performance of a toxin EIA is not necessary in cases with a negative GDH EIA (or NAAT) result. Notes: A cell cytotoxin assay may be considered as an alternative to a sensitive toxin EIA, but yields slower results (l-2 days), and this will need to be taken into account in making decisions about infection control. Reproduced with permission. ©Crown copyright 2012; http://www.nationalarchives.gov.uk/doc/open-government-licence/open-government-licence.htm Clinical Microbiology and Infection 2012 18, 13-20DOI: (10.1111/1469-0691.12057) Copyright © 2012 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions