Abstract
Between January and April 1993, culture forClostridium difficile and a faecal cytotoxin assay were performed on 500 selected specimens. Isolates from culture-positive patients from whom faecal samples were cytotoxin negative were also examined in vitro for cytotoxin production. The significance of a positive culture result in the absence of faecal cytotoxin was assessed. Forty-one of the 500 specimens were toxin positive. In only 25 of these wasClostridium difficile examination specifically requested. Six of nine culture-positive cytotoxin-negative patients (11 specimens) had recently received antibiotics. In four of these,Clostridium difficile was considered to be of possible clinical significance. Culture and in vitro determination of toxin production of isolates may aid in the diagnosis of some additional cases, but cytotoxin detection remains the single optimal routine laboratory method for diagnosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Knoop FC, Owens M, Crocker IC:Clostridium difficile: clinical disease and diagnosis. Clinical Microbiology Reviews 1993, 6: 251–265.
McFarland LV, Mulligan ME, Kwok RYY, Stamm WE: Nosocomial acquisition ofClostridium difficile infection. New England Journal of Medicine 1989, 320: 204–210.
Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN: NosocomialClostridium difficile colonisation and disease. Lancet 1990, 336: 97–100.
Wilcox MH, Spencer RC:Clostridium difficile infection: responses, relapses and re-infections. Journal of Hospital Infection 1992, 22: 85–92.
Fan K, Morris AJ, Reller LB: Application of rejection criteria for stool cultures for bacterial enteric pathogens. Journal of Clinical Microbiology 1993, 31: 2233–2235.
Bowman RA, Bowman JM, Arrow SA, Riley TV: Selective criteria for the microbiological examination of faecal specimens. Journal of Clinical Pathology 1992, 45: 838–839.
Borriello SP: An evaluated micromethod for the detection ofClostridium difficile enterotoxin. Microbios Letters 1978, 7: 25–28.
George WL, Sutter VL, Citron D, Finegold SM: Selective and differential medium for isolation ofClostridium difficile. Journal of Clinical Microbiology 1979, 9: 214–219.
Bowman RA, Arrow SA, Riley TV: Latex particle agglutination for detecting and identifyingClostridium difficile. Journal of Clinical Pathology 1986, 39: 212–214.
Borriello SP, Barclay FE:Clostridium difficile in the elderly. Journal of Infection 1991, 22: 310–312.
Hall S:Clostridium difficile — epidemiological aspects. PHLS Microbiology Digest 1993, 10: 87–90.
Cefai C, Elliott TSJ, Woodhouse KW: Gastrointestinal carriage rate ofClostridium difficile in elderly, chronic care hospital patients. Journal of Hospital Infection 1988, 11: 335–339.
Department of Health/Public Health Laboratory Service Joint Working Group:Clostridium difficile infection. Prevention and Management. PHLS, London, 1994.
Merz CS, Kramer C, Forman M, Gluck L, Mills K, Senft K, Steiman I, Wallace N, Charache P: Comparison of four commercially available rapid enzyme immunoassays with cytotoxin assay for detection ofClostridium difficile toxin(s) from stool specimens. Journal of Clinical Microbiology 1994, 32: 1142–1147.
Barbut F, Kajzer C, Planas N, Petit JC: Comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis ofClostridium difficile-associated diarrhoea. Journal of Clinical Microbiology 1993, 31: 963–967.
Bowman RA, O'Neill GL, Riley TV: Non-radioactive restriction fragment length polymorphism (RFLP) typing ofClostridium difficile. FEMS Microbiology Letters 1991, 63: 269–272.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bond, F., Payne, G., Borriello, S.P. et al. Usefulness of culture in the diagnosis ofClostridium difficile infection. Eur. J. Clin. Microbiol. Infect. Dis. 14, 223–226 (1995). https://doi.org/10.1007/BF02310360
Issue Date:
DOI: https://doi.org/10.1007/BF02310360