Organism burden, toxin concentration, and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with Clostridium difficile
Organism burden, toxin concentration, and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with Clostridium difficile
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DOI：
10.1016/j.diagmicrobio.2015.11.022
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发表时间：
2016-04-01
影响因子：
2.9
通讯作者：
Banaei, Niaz
中科院分区：
文献类型：
--
作者：
Anikst, Victoria Emma;Gaur, Rajiv Lochan;Banaei, Niaz
在轻度腹泻患者中，艰难梭菌感染常被过度诊断。我们评估了4种生物标志物作为59例有临床显著腹泻的pcr阳性患者和59例无临床显著腹泻的pcr阳性患者的临床显著腹泻（>= 24小时内3次发作）的替代品。机体负荷（tcdB循环阈值中位数，26.9 vs 27.1, P = 0.25）和毒素A和毒素B浓度（毒素A中位数，0 vs 0 ng/mL, P = 0.42；毒素B中位数，0 vs 0 ng/mL, P = 0.25）在有和没有临床显著性腹泻的患者之间无显著差异。腹泻患者粪乳铁蛋白浓度显著升高（中位数为99.0 vs 55.1 μ g/mL, P = 0.05）；然而，乳铁蛋白不能充分地将患者区分为有和没有临床显著腹泻的患者。需要采取干预措施，将艰难梭菌检测限制在有临床显著腹泻的患者中，以提高艰难梭菌诊断的阳性预测值。(C) 2016 Elsevier Inc.版权所有。
Clostridium difficile infection is often overdiagnosed in patients with mild diarrhea. We evaluated 4 biomarkers as surrogates for clinically significant diarrhea (>= 3 episodes in 24 hours) in 59 PCR-positive patients with and 59 PCR-positive patients without clinically significant diarrhea. Organism burden (median tcdB cycle threshold value, 26.9 versus 27.1, P = 0.25) and toxin A and B concentrations (toxin A, median, 0 versus 0 ng/mL, P = 0.42; toxin B, median, 0 versus 0 ng/mL, P = 0.25) were not significantly different between patients with and without clinically significant diarrhea. Fecal lactoferrin concentrations were significantly increased in patients with clinically significant diarrhea (median, 99.0 versus 55.1 mu g/mL, P = 0.05); however, lactoferrin could not sufficiently classify patients into those with and without clinically significant diarrhea. Interventions that limit C. difficile testing to patients with clinically significant diarrhea are needed to improve the positive predictive value of C. difficile diagnostics. (C) 2016 Elsevier Inc. All rights reserved.