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Title: Assessment of the utility of repeat stool testing for Clostridium difficile stool toxin using enzyme immunoassay
Authors: Galea, Karl
Barbara, Christopher
Borg, Michael Angelo
Keywords: Diarrhea
Diagnosis, Laboratory -- Malta
Clostridium difficile -- Malta
Feces -- Examination -- Malta
Immunoenzyme technique
Issue Date: 2015-12
Publisher: Malta Journal of Health Sciences
Citation: Malta Journal of Health Sciences. 2015, Vol.2(2), p. 61-65
Abstract: The poor performance of toxin enzyme immunoassay (EIA) for laboratory testing for Clostridium difficile (C. difficile) infection (CDI) is well acknowledged. Guidelines published in recent years state that testing solely with EIA for detecting toxins A and B is sub-optimal. As a consequence, clinicians may lose confidence in the test and submit multiple samples to offset the poor sensitivity of the toxin EIA. This leads to waste of laboratory resources and is discouraged by recent guidelines. 2,489 requests for toxin EIA submitted during one year at a state general hospital in Malta were reviewed to assess the utility of repeat stool testing for C. difficile toxin detection using toxin EIA and also to gather data on the extent of repeat samples within 28 days of a positive test. There were a total of 1,970 diarrhoeal episodes, from which a total of 302 cases (15.3%) submitted more than one sample for repeated testing. Only 2% of these repeats tested positive after having an initial negative result for the C. difficile toxin EIA test. Most recent published practice guidelines recommend a two-step or three-step testing algorithm in the diagnosis of C. difficile-associated diarrhoea, which offers a marked increase in sensitivity when compared to that of toxin A and B EIA alone. A three-step protocol is proposed which should enable the discernment of the role of C. difficile in a diarrhoeal patient.
Appears in Collections:MJHS, Volume 2, Issue 2
MJHS, Volume 2, Issue 2

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