Background

Clostridium difficile (CD) diagnosis are very varied and under discussion. Different research groups disagree on the clinical significance of patients with negative direct toxin and positive PCR or even more with direct toxin and GDH both negatives, but CD detected by toxigenic culture (TC).

Objective

Analyze the characteristics of patients with three different diagnostic criteria.

Methods

We compared these three groups of patients: group 1:(GDH+/direct toxin+/PCR+), group 2:(GDH+/direct toxin-/PCR+) and group 3:(GDH-/direct toxin-/PCR not done/TC+).

Results

The proportion of patients with CD infection (CDI) (not colonization) for groups 1 to 3 were, respectively, 90.3%, 95.4% and 59.1%. No differences between severity (40.8%-38.5%-27.3%), recurrence (20.3%-24.1%-7.6%) or related mortality (12.5%-5.2%-0%) were found within the three groups of patients.

Conclusions

Laboratory clinical results should not be used as the only tool to differentiate CDI versus colonization or severity. We recommend that PCR or a second look TC be performed on all patients.

中文翻译：

---

艰难梭菌实验室检测呈阳性的三种不同模式。临床行为比较。

背景

艰难梭菌（CD）诊断的差异很大，并且正在讨论中。不同研究小组对直接毒素阴性，PCR阳性或什至更多直接毒素和GDH均为阴性的患者的临床意义存在分歧，但通过产毒培养（TC）检测到CD。

目的

用三种不同的诊断标准分析患者的特征。

方法

我们比较了这三组患者：第1组：（GDH + /直接毒素+ / PCR +），第2组：（GDH + /直接毒素-/ PCR +）和第3组：（GDH- /直接毒素-/ PCR未完成/ TC +） 。

结果

第1至3组的CD感染（CDI）（非定植）患者所占比例分别为90.3％，95.4％和59.1％。在三组患者中，严重程度（40.8％-38.5％-27.3％），复发率（20.3％-24.1％-7.6％）或相关死亡率（12.5％-5.2％-0％）之间没有差异。

结论

实验室临床结果不应用作区分CDI与定植或严重程度的唯一工具。我们建议对所有患者进行PCR或第二眼TC。