Objective: Clostridium difficile is recognized as the major causative agent in nosocomial and antibiotic associated diarrhoea. C.difficile is an opportunistic organism in the gut. Antibiotic exposure disrupts normal intestinal flora allowing for the proliferation of C.difficile. Because most patients will acquire this organism through nosocomial infection, an accurate and rapid diagnosis of C.difficile infection is essential to allow for fast, appropriate treatment and prompt infection control intervention.
This study compared two rapid molecular forms of C.difficile toxin detection. The Cepheid® Xpert C.difficile Assay utilizes automated real-time polymerase chain reaction (PCR). The Meridian illumigene™ uses Loop Mediated Amplification (LAMP) technology. The focus of this evaluation was to compare the two technologies as far as test performance, ease of use and workflow were concerned and to ascertain how a more rapid TAT could clinically impact patient management and infection control intervention.
Method: Faecal samples requesting C.difficle toxin testing were analysed in tandem using the two technologies.
Result: 141 samples were analysed. 116 samples were concordant negatives, 11 were concordant positives. Eleven samples (7.8%) were discordant.
Conclusion: The benefits of the Cepheid® Xpert C.difficile Assay are as follows; fewer invalid results, the ability to presumptively screen for the emerging “epidemic” strains of C.difficile (027/NAP1/B1), and minimal sample processing allowing for a rapid TAT (average 2hrs). Faster time to result means a quicker differential diagnosis of CDI from other forms of hospital and community acquired diarrhoea. Treatment can be implemented earlier, reducing the risk of transmission, and progression of the infection to a more severe form of the disease, especially in patients with existing comorbidities. Earlier diagnosis and treatment of CDI lowers the cost burden on the health system by reducing the time a patient is kept in isolation and decreases the overall length of their hospital stay.