European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection
European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection
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DOI：
10.1016/j.cmi.2016.03.010
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发表时间：
2016-08-01
影响因子：
14.2
通讯作者：
Kuijper, E. J.
中科院分区：
文献类型：
--
作者：
Crobach, M. J. T.;Planche, T.;Kuijper, E. J.
2009年，欧洲临床微生物学和传染病学会（ESCMID）发布了第一个诊断艰难梭菌感染（CDI）的指南。从那时起，用于诊断CDI的新测试变得可用，特别是核酸扩增测试。本次指南文件更新的主要目的是总结目前有关CDI实验室诊断的可用证据，并制定和修订优化CDI检测的建议。这一更新对于改善CDI的诊断和提高欧洲监测目的CDI诊断的一致性至关重要。对CDI实验室诊断相关文献进行了电子检索。评价商业实验室检测与参考检测相比的研究也纳入荟萃分析中。评估的商业测试包括检测谷氨酸脱氢酶的酶免疫测定（EIA）、检测毒素A和B的EIA以及核酸扩增测试。建议由一个执行委员会制定，建议的力度和证据的质量采用建议评估、发展和评价等级（GRADE）系统进行分级。由于在低CDI患病率下阳性预测值不足，因此没有单一的商业检测可用作诊断CDI的独立检测。因此，建议使用两步算法。毒素A和B EIA检测无游离毒素，但谷氨酸脱氢酶EIA、核酸扩增试验或致突变培养结果阳性的样本需要临床评价，以区分CDI和无症状携带。M.J.T. Crobach，CMI 2016;22：S63（C）2016作者。由Elsevier Ltd代表欧洲临床微生物学和传染病学会出版。
In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched. Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests. The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing. This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed. Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests. Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence. Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage. M.J.T. Crobach, CMI 2016;22:S63 (C) 2016 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.