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  • Title: ["Second look" at cytotoxin B of Clostridium difficile in the course of diarrhea associated with antibiotic therapy].
    Author: Sednaoui P, el Mantih B, Cauwell M.
    Journal: Pathol Biol (Paris); 1999 May; 47(5):415-21. PubMed ID: 10418011.
    Abstract:
    UNLABELLED: Clostridium difficile is a sporulated obligate anaerobe responsible for most cases of antibiotic-associated colitis, for 15 to 25% of cases of antibiotic-related diarrhea, and for a substantial proportion of nosocomial infections. The most important laboratory test for the diagnosis of C. difficile infection is examination of the stool for C. difficile toxins A and/or B. Detection of cytotoxin B using the direct cytotoxicity assay (D-CA) is the gold standard test. Whether routine isolation of the organism from stool is warranted remains controversial. OBJECTIVES: To evaluate second-look CA done on C. difficile culture-positive filtrates from stool samples negative by the D-CA. METHODS: 300 consecutive stool samples sent to the Alfred Fournier Institute from April through October 1998 for a CA were routinely cultured on modified Cefoxitin Cycloserine Fructose Agar medium (CCFA). All CA-negative samples that grew C. difficile were examined by second-look CA. RESULTS: 245 stool specimens (81.7%) were negative by both CA and culture. The remaining 55 specimens all yielded C. difficile by culture; 32 (58.2%) had a positive D-CA and nine (16.4%) a negative D-CA with a positive second-look CA done on culture filtrates. CONCLUSION: Our data suggest that stool specimens sent for a direct CA should be routinely cultured to provide material for a second-look CA on culture-positive filtrates if the first CA prove negative. Culturing also allows to study antimicrobial drug resistance phenotypes and epidemiological markers.
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