Diagnostic role of endoscopy, stool culture, and toxin A in Clostridium difficile-associated disease

This retrospective study was designed to assess the roles of stool culture for Clostridium difficile, detection of the presence of toxin A, and endoscopic examination in the diagnosis of Clostridium difficile-associated disease (CDAD). From January 1994 through September 1996, there were 213 patient...

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Published inJournal of the Formosan Medical Association Vol. 96; no. 11; pp. 879 - 883
Main Authors Wei, S C, Wong, J M, Hsueh, P R, Shieh, M J, Wang, T H, Luh, K T, Wang, C Y
Format Journal Article
LanguageEnglish
Published Singapore 01.11.1997
Subjects
Adolescent
Adult
Aged
Aged, 80 and over
Bacterial Toxins
Child
Child, Preschool
Endoscopy, Gastrointestinal
Enterocolitis, Pseudomembranous - diagnosis
Enterocolitis, Pseudomembranous - drug therapy
Enterotoxins - analysis
Feces - microbiology
Female
Humans
Infant
Male
Middle Aged
Retrospective Studies
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Summary:This retrospective study was designed to assess the roles of stool culture for Clostridium difficile, detection of the presence of toxin A, and endoscopic examination in the diagnosis of Clostridium difficile-associated disease (CDAD). From January 1994 through September 1996, there were 213 patients with stool cultures positive for C. difficile in National Taiwan University Hospital. Of these, 126 had CDAD. There were 87 asymptomatic carriers of C. difficile in our study, 12 of whom were positive for toxin A. In addition, seven patients with pseudomembranous colitis (PMC), who were either culture-negative or not tested, were included in the study. The positive predictive values of stool cultures for CDAD and PMC were 59% and 32%, respectively. The positive predictive values of toxin A for CDAD and PMC were 41% and 43%, respectively. Seventy-eight patients (59%) improved with supportive treatment after discontinuing antibiotics. We concluded that stool culture for C. difficile and discontinuation of antibiotics should be the standard approach for patients with suspected CDAD. Endoscopic studies can eliminate some other possible causes of diarrhea such as inflammatory bowel disease, allow biopsies of suspicious lesions, and reveal the severity of CDAD. Toxin assay results need to be interpreted together with the clinical data.
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ISSN:0929-6646