Prevalence of diagnostically-discrepant Clostridioides difficile clinical specimens: insights from longitudinal surveillance.
Prevalence of diagnostically-discrepant Clostridioides difficile clinical specimens: insights from longitudinal surveillance.
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DOI：
10.3389/fmed.2023.1238159
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发表时间：
2023
影响因子：
3.9
通讯作者：
Vedantam, Gayatri
中科院分区：
文献类型：
--
作者：
Anwar, Farhan;Clark, Marielle;Lindsey, Jason;Claus-Walker, Rachel;Mansoor, Asad;Nguyen, Evy;Billy, Justin;Lainhart, William;Shehab, Kareem;Viswanathan, V. K.;Vedantam, Gayatri
艰难梭菌感染（CDI）是一种全球流行的卫生保健相关腹泻疾病。一种常见的诊断算法依赖于两步方案，分别使用粪便酶免疫测定法（eia）检测病原体及其毒素。当毒素EIA结果为阴性时，活性CDI被认为不太可能，即使病原体特异性EIA对艰难梭菌呈阳性。然而，我们最近报道，从毒素阴性（“差异”）临床粪便标本中恢复的低产毒艰难梭菌菌株可以完全致病，并在啮齿动物CDI模型中导致死亡。为了记录差异CDI标本的频率，并评估艰难梭菌菌株多样性，我们在亚利桑那州南部的一家三级医院进行了纵向监测。研究人员从南亚利桑那州一家拥有600个床位的医疗中心的所有住院和门诊部门收集了8年（2015-2022年）期间临床疑似CDI患者的腹泻粪便标本。临床实验室EIA检测鉴定出含有艰难梭菌的标本，并将其分类为毒素阳性或毒素阴性。利用国际系统发育谱系分配系统（“核糖分型”）对从粪便标本中分离出的艰难梭菌进行DNA指纹鉴定。对选定的分离株，用EIA定量纯培养物固定相上清液中的毒素丰度。在接受诊断检测的8,910例腹泻标本中，1733例（19.4%）携带艰难梭菌。结果表明：(1)艰难梭菌的流行率和系统发育多样性在8年的时间内保持稳定；(2)产毒艰难梭菌在临床x-阴性（“差异”）标本中检出69%；(3) 6种最常见的美国核型在x-阴性标本中恢复的比例显著（约60%）；(4)从差异标本中分离出的产毒素艰难梭菌比从非差异标本中分离出的相同核糖型菌株产生的毒素少。我们的研究强调了毒素eia阴性CDI标本在临床环境中的优势地位，以及这些标本中已知毒性核型的高频率。因此，对诊断差异标本的临床相关性进行仔细的重新评估，特别是在CDI漏诊和艰难梭菌持续性的背景下，是有必要的。
Clostridioides difficile Infection (CDI) is a healthcare-associated diarrheal disease prevalent worldwide. A common diagnostic algorithm relies on a two-step protocol that employs stool enzyme immunoassays (EIAs) to detect the pathogen, and its toxins, respectively. Active CDI is deemed less likely when the Toxin EIA result is negative, even if the pathogen-specific EIA is positive for C. difficile. We recently reported, however, that low-toxin-producing C. difficile strains recovered from Toxin-negative (‘discrepant’) clinical stool specimens can be fully pathogenic, and cause lethality in a rodent CDI model. To document frequency of discrepant CDI specimens, and evaluate C. difficile strain diversity, we performed longitudinal surveillance at a Southern Arizona tertiary-care hospital. Diarrheic stool specimens from patients with clinical suspicion of CDI were obtained over an eight-year period (2015–2022) from all inpatient and outpatient Units of a > 600-bed Medical Center in Southern Arizona. Clinical laboratory EIA testing identified C. difficile-containing specimens, and classified them as Toxin-positive or Toxin-negative. C. difficile isolates recovered from the stool specimens were DNA fingerprinted using an international phylogenetic lineage assignment system (“ribotyping”). For select isolates, toxin abundance in stationary phase supernatants of pure cultures was quantified via EIA. Of 8,910 diarrheic specimens that underwent diagnostic testing, 1733 (19.4%) harbored C. difficile. Our major findings were that: (1) C. difficile prevalence and phylogenetic diversity was stable over the 8-year period; (2) toxigenic C. difficile was recovered from 69% of clinically Tox-neg (‘discrepant’) specimens; (3) the six most prevalent USA ribotypes were recovered in significant proportions (>60%) from Tox-neg specimens; and (4) toxin–producing C. difficile recovered from discrepant specimens produced less toxin than strains of the same ribotype isolated from non-discrepant specimens. Our study highlights the dominance of Toxin EIA-negative CDI specimens in a clinical setting and the high frequency of known virulent ribotypes in these specimens. Therefore, a careful reevaluation of the clinical relevance of diagnostically-discrepant specimens particularly in the context of missed CDI diagnoses and C. difficile persistence, is warranted.
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美国梭菌艰难梭菌感染和结果负担的趋势。
DOI：
10.1056/nejmoa1910215
发表时间：
2020-04-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Guh AY;Mu Y;Winston LG;Johnston H;Olson D;Farley MM;Wilson LE;Holzbauer SM;Phipps EC;Dumyati GK;Beldavs ZG;Kainer MA;Karlsson M;Gerding DN;McDonald LC;Emerging Infections Program Clostridioides difficile Infection Working Group
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Emerging Infections Program Clostridioides difficile Infection Working Group
影响因子：
3
作者：
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通讯作者：
Kuijper EJ
影响因子：
6.9
作者：
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通讯作者：
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DOI：
10.1093/cid/ciy171
发表时间：
2018-08-16
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
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通讯作者：
Dorr MB
DOI：
10.1016/j.diagmicrobio.2015.11.022
发表时间：
2016-04-01
影响因子：
2.9
作者：
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通讯作者：
Banaei, Niaz