Impact of the introduction of nucleic acid amplification testing on Clostridioides difficile detection and ribotype distribution in Wales,Anaerobe

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Impact of the introduction of nucleic acid amplification testing on Clostridioides difficile detection and ribotype distribution in Wales
Anaerobe ( IF 2.5 ) Pub Date : 2020-12-09 , DOI: 10.1016/j.anaerobe.2020.102313
Michael D Perry ₁ , P Lewis White ₁ , Trefor E Morris ₁

Affiliation

Objectives

To determine the impact of the 2018 introduction of nucleic acid amplification tests (NAATs) for C. difficile detection on the laboratory diagnosis of C. difficile infection (CDI), and the distribution of C. difficile ribotypes.

Methods

A retrospective analysis of five years (2015–2019) of C. difficile diagnostic laboratory and PCR ribotyping test results.

Results

A total of 255,104 diagnostic results, from 136,353 patients were analysed: 199,794 samples where glutamate dehydrogenase (GDH) was used as the primary screen; and 55,310 where NAATs were employed. An overall decrease in frontline positivity from 2015 to 2019 (10.3% [n = 5017] to 6% [n = 3190] - p < 0.0001) was observed, despite an increase in the number of samples tested (48,778 to 52,839). NAAT positivity was lower than GDH (p < 0.0001) for the two years where it was implemented. The variance was accounted for by increased overall C. difficile isolation and reduced toxin negative strain culture from NAAT positive samples (p < 0.0001). Ribotype distribution (6546 samples) remained stable with decreasing RT27 isolation in each year except 2017 (p < 0.0001). RT78 was associated with toxin A/B EIA positivity (p < 0.0001).

Conclusions

Use of NAAT for the detection of C. difficile, as part of a 2-step algorithm, has not led to an increase in CDI laboratory diagnostic test positivity. In spite of ribotype distribution being comparable for screening in toxin A/B positive samples, there is a significantly greater correlation between NAAT positivity and culture of toxigenic strains compared to GDH.

中文翻译：

引入核酸扩增检测对威尔士艰难梭菌检测和核糖型分布的影响

目标

确定 2018 年引入的艰难梭菌检测核酸扩增试验 (NAAT) 对艰难梭菌感染 (CDI)的实验室诊断和艰难梭菌核糖型分布的影响。

方法

艰难梭菌诊断实验室五年（2015-2019 年）的回顾性分析和 PCR 核糖分型检测结果。

结果

分析了来自 136,353 名患者的总共 255,104 个诊断结果：199,794 个样本，其中使用谷氨酸脱氢酶 (GDH) 作为初步筛选；和 55,310，其中使用了 NAAT。尽管测试的样本数量有所增加（48,778 到 52,839），但观察到前线阳性率从 2015 年到 2019 年总体下降（10.3% [n = 5017] 到 6% [n = 3190] - p < 0.0001）。在实施的两年中，NAAT 的阳性率低于 GDH（p < 0.0001）。差异是由整体增加的艰难梭菌引起的从 NAAT 阳性样品中分离和减少毒素阴性菌株培养物 (p < 0.0001)。核糖型分布（6546 个样本）保持稳定，除 2017 年外，每年的 RT27 分离都在减少（p < 0.0001）。RT78 与毒素 A/B EIA 阳性相关（p < 0.0001）。