Diagnosis of Clostridium difficile-associated disease: examination of multiple algorithms using toxin EIA, glutamate dehydrogenase EIA and loop-mediated isothermal amplification

The laboratory diagnosis of Clostridium difficile infection (CDI) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. Three methods are evaluated using 810 consecutive stool samples against toxigenic culture: CDT TOX A/B Premier enzyme immunoassay (EIA) kit (Meridian Bioscience, Europe), Premier EIA for C. difficile glutamate dehydrogenase (GDH) (Meridian Bioscience, Europe) and the Illumigene kit (Meridian Bioscience, Europe), both individually and within combined testing algorithms. The study revealed that the CDT TOX A/B Premier EIA gave rise to false-positive and false-negative results and demonstrated poor sensitivity (56.47%), compared to Premier EIA for C. difficile GDH (97.65%), suggesting this GDH EIA can be a useful negative screening method. Results for the Illumigene assay alone showed sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 91.57%, 98.07%, 99.03% and 84.44%, respectively. A two-stage algorithm using Premier EIA for C. difficile GDH/Illumigene assay yielded superior results compared with other testing algorithms (91.57%, 98.07%, 99.03% and 84.44%, respectively), mirroring the Illumigene performance. However, Illumigene is approximately half the cost of current polymerase chain reaction (PCR) methods, has a rapid turnaround time and requires no specialised skill base, making it an attractive alternative to assays such as the Xpert C. difficile assay (Cepheid, Sunnyvale, CA). A three-stage algorithm offered no improvement and would hamper workflow.

An assessment of triclosan susceptibility in methicillin-resistant and methicillin-sensitive Staphylococcus aureus

Triclosan is widely used to reduce skin colonization with staphylococci and is incorporated into methicillin-resistant Staphylococcus aureus (MRSA) eradication regimes. Using an agar dilution method, the minimum inhibitory concentration (MIC) to triclosan was determined for 186 isolates of MRSA and methicillin sensitive Staphylococcus aureus (MSSA). Fourteen isolates (7.5%) were detected with a MIC > or = 1.0 part per million (ppm). There was no significant difference between the incidence of triclosan resistance in strains of MSSA and MRSA. None of 16 strains of MRSA which exhibited low-level mupirocin resistance had MIC's > or = 1.0 ppm. Increased MIC's of staphylococci to triclosan may contribute to treatment failure when used to eradicate staphylococcal carriage. We suggest that routine susceptibility testing of staphylococci against triclosan might now be indicated.