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Chapter 16 : Molecular Diagnostics for

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Molecular Diagnostics for , Page 1 of 2

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Abstract:

is the most important cause of health care-associated diarrhea in developed countries (1–3). During the past decade, the emergence of an epidemic strain, termed PCR-ribotype 027 or North American pulsed-field gel electrophoresis type 1 (NAP1), has been associated with dramatic increases in the incidence and severity of infection (CDI) in North America and Europe (1, 4). In the United States, now causes more hospital-onset infections than any other pathogen (∼80,000 infections annually), resulting in an estimated 14,000 deaths each year (2, 3). Moreover, these numbers greatly underestimate the true burden of CDI because up to 75% of cases in the United States now have their onset in long-term care facilities or the community (2).

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
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Image of FIGURE 1
FIGURE 1

Different diagnostic methods and their targets. +, advantages; –, disadvantages; NPV, negative predictive value. Adapted from reference .

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
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Image of FIGURE 2
FIGURE 2

Two-step diagnostic testing algorithm for CDI from the United Kingdom Department of Health/Advisory Committee on Antimicrobial Resistance and Health Care Associated Infection ( ). A relatively sensitive EIA for toxin A and B is recommended. Patients with positive GDH or NAAT but negative EIA are classified as potential excretors (i.e., asymptomatic carriers with diarrhea not due to CDI). Fecal excretors may be isolated to prevent cross-transmission, but not routinely treated unless indicated based on clinical interpretation.

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
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Image of FIGURE 3
FIGURE 3

Kaplan-Meier curves showing time to conversion of CDI test results from positive to negative during CDI therapy, by test type (toxigenic culture, PCR for toxin B genes, and GDH). Reprinted from reference .

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
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Image of FIGURE 4
FIGURE 4

Percentage of positive perirectal PCR results and skin and environment cultures for long-term care facility residents with asymptomatic carriage of based on positive perirectal cultures, stratified by the number of colonies recovered per swab. Skin sites cultured included the groin and combined chest and abdomen. Environmental sites cultured included the bed rail and bedside table. Twenty-five sets of specimens were collected from 21 asymptomatic carriers. Reprinted from reference .

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
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Tables

Generic image for table
TABLE 1

Comparison of current diagnostic methods

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16
Generic image for table
TABLE 2

Summary of three recent studies that have examined the impact of interventions to expedite CDI testing

Citation: Barbut F, Donskey C. 2016. Molecular Diagnostics for , p 185-196. In Persing D, Tenover F, Hayden R, Ieven M, Miller M, Nolte F, Tang Y, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555819071.ch16

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