The predictive value of quantitative nucleic acid amplification detection of Clostridium difficile toxin gene for faecal sample toxin status and patient outcome
The predictive value of quantitative nucleic acid amplification detection of Clostridium difficile toxin gene for faecal sample toxin status and patient outcome
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DOI：
10.1371/journal.pone.0205941
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发表时间：
2018-12-05
期刊：
影响因子：
3.7
通讯作者：
Wilcox, Mark H.
中科院分区：
文献类型：
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作者：
Davies, Kerrie A.;Planche, Tim;Wilcox, Mark H.
尽管指南不断更新，但艰难梭菌感染（CDI）的实验室诊断仍不稳定。我们研究了核酸扩增试验（NAAT）的定量数据对C。艰难梭菌毒素基因（tg）的患者管理。艰难梭菌诊断研究（7335例患者的8853份尿液样本），我们确定了C.艰难梭菌tgNAAT（Cepheid Xpert C. diff）患者毒素阳性状态、CDI严重性、死亡率和CDI复发的低循环阈值（CT）值。CDI诊断的参考方法是细胞毒性试验（CTA）和细胞增殖培养（CTC）。结果在1281份tgNAAT阳性粪便样本中，CTA和CTC阳性分别为713和917份。死亡患者的中位tgNAAT CT为25.5，存活患者为27.5（p = 0.021）;毒素阳性患者为24.9，毒素阴性患者为31.6（p
BackgroundLaboratory diagnosis of Clostridium difficile infection (CDI) remains unsettled, despite updated guidelines. We investigated the potential utility of quantitative data from a nucleic acid amplification test (NAAT) for C. difficile toxin gene (tg) for patient management.MethodsUsing data from the largest ever C. difficile diagnostic study (8853 diarrhoeal samples from 7335 patients), we determined the predicative value of C. difficile tgNAAT (Cepheid Xpert C. diff) low cycle threshold (CT) value for patient toxin positive status, CDI severity, mortality and CDI recurrence. Reference methods for CDI diagnosis were cytotoxicity assay (CTA) and cytotoxigenic culture (CTC).ResultsOf 1281 tgNAAT positive faecal samples, 713 and 917 were CTA and CTC positive, respectively. The median tgNAAT CT for patients who died was 25.5 vs 27.5 for survivors (p = 0.021); for toxin-positivity was 24.9 vs 31.6 for toxin-negative samples (p