אילמ"ר - האיגוד הישראלי למדעי המעבדה הרפואית

אילמ"ר - האיגוד הישראלי למדעי המעבדה הרפואית

כינוס שנתי ה-46 | 2012

פוסטרים להצגה בכינוס

Improved C. difficile detection in a Community Hospital in Israel by Implementing glutamate dehydrogenase and molecular technology based algorithm

O. SCHWARTZ HARARI1, E. LERNER1, Y. KAZMIN1, T. GOTTESMAN2
1. Microbiology Laboratory, 2. Infectious Disease Unit, Edith Wolfson Medical Center Holon Israel

 

Objectives: Clostridium difficile is a gram positive spore forming rod that grows anaerobically. Strains of C. difficile that produce the toxins A (tcdA) and B (tcdB) are known to be the causative agents of C. difficile- associated diarrhea (CDAD), antibiotic associated diarrhea and pseudo membranous colitis (PMC).

Accurate and rapid diagnosis of C. difficile is essential for patient management particularly in an older population, and infection control. New C.difficile guidelines were recommended by ESCMID ( December 2009), SHEA-IDSA ( May 2010) and ASM ( September 2010). In our laboratory we adopted the new guidelines in May 2011 (the ASM 2 step algorithm: glutamate dehydrogenase [GDH] + toxin followed by molecular confirmation). The aim of this study is to have a look back on the utility and benefit of this new algorithm.

Methods: In 2009 and 2010 diarrheal stool samples were collected from symptomatic patients as part of routine clinical care at the E. Wolfson Medical Center in Israel. Samples were tested by ELISA PremierTM Toxins A&B (Meridian Bioscience). As of May 2011 the diarrheal stool samples were screened by C. diff Quik-chek  completeR(TechlabR). Positive results for either one of the tests - GDH or TOX- were followed by Illumigene (Meridian Bioscience), a molecular method that served as a confirmatory test (LAMP). Results: In 2009 a total of 655 patients (59 pediatric, 596 adult) were tested, of which 47 cases were positive (7%). In 2010 a total of 608 patients (38 pediatric, 570 adult) were tested, of which 51 cases were positive (8%).  In 2011 a total of 658 (39 pediatric, 619 adult) patients were tested, of which 86 cases were positive (13%).  The mean age of patients over 2009-2011 was similar.

Conclusions: While the number of tests performed to look for C. difficile over 2009-2011 did not increase, suggesting a steady incidence of C. difficile, there was a significant rise in the rate of positive tests in 2011 compared to 2009 (OR= 1.94, p-value<0.001) and 2010 (OR=1.64, p-value=0.004). No significant rise was found between 2009 and 2010. These findings indicate that the new adopted algorithm (using the Illumigene molecular assay for confirmation), albeit costly, is more sensitive than the former one for the detection of C. difficile. It leads to a rapid and accurate diagnosis of C. difficile resulting in better patient-care and infection control. It would probably be found in the near future to be cost-effective.

 

לתכנית הכנס     חזרה לריכוז הפוסטרים 2012
דף הבית | מי אנחנו | רישום לאילמ"ר ולאתר | תקנון | חברי הועד | מערכת האתר | צור קשר | מקצוע המעבדנות הרפואית | מישיבות ועד אילמ"ר | המועצה למעבדות במשה"ב |
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