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Updates on Clostridium difficile in Europe

Overview of attention for book
Attention for Chapter 3: Diagnostic Guidance for C. difficile Infections
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Chapter title
Diagnostic Guidance for C. difficile Infections
Chapter number 3
Book title
Updates on Clostridium difficile in Europe
Published in
Advances in experimental medicine and biology, January 2018
DOI 10.1007/978-3-319-72799-8_3
Pubmed ID
Book ISBNs
978-3-31-972798-1, 978-3-31-972799-8
Authors

Monique J. T. Crobach, Amoe Baktash, Nikolas Duszenko, Ed J. Kuijper, Crobach, Monique J. T., Baktash, Amoe, Duszenko, Nikolas, Kuijper, Ed J.

Abstract

Diagnosis of Clostridium difficile infection (CDI) can be challenging. First of all, there has been debate on which of the two reference assays, cell cytotoxicity neutralization assay (CCNA) or toxigenic culture (TC) should be considered the gold standard for CDI detection. Although the CCNA suffers most from suboptimal storage conditions and subsequent toxin degradation, TC is reported to falsely increase CDI detection rates as it cannot differentiate CDI patients from patients asymptomatically colonised by toxigenic C. difficile. Several rapid assays are available for CDI detection and fall into three broad categories: (1) enzyme immunoassays for glutamate dehydrogenase, (2) enzyme immunoassays for toxins A/B and (3) nucleic acid amplification tests detecting toxin genes. All three categories have their own limitations, being suboptimal specificity and/or sensitivity or the inability to discern colonised patients from CDI patients. In light of these limitations, multi-step algorithmic testing has now been advocated by international guidelines in order to optimize diagnostic accuracy. Despite these recommendations, testing methods between hospitals vary widely, which impacts CDI incidence rates. CDI incidence rates are also influenced by sample selection criteria, as several studies have shown that if not all unformed stool samples are tested for CDI, many cases may be missed due to an absence of clinical suspicion. Since methods for diagnosing CDI remain imperfect, there has been a growing interest in alternative testing strategies like faecal biomarkers, immune modulating interleukins, cytokines and imaging methods. At the moment, these alternative methods might play an adjunctive role, but they are not suitable to replace conventional CDI testing strategies.

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Mendeley readers

The data shown below were compiled from readership statistics for 27 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 27 100%

Demographic breakdown

Readers by professional status Count As %
Other 5 19%
Researcher 5 19%
Student > Master 3 11%
Student > Postgraduate 2 7%
Student > Doctoral Student 1 4%
Other 4 15%
Unknown 7 26%
Readers by discipline Count As %
Biochemistry, Genetics and Molecular Biology 7 26%
Immunology and Microbiology 5 19%
Medicine and Dentistry 4 15%
Agricultural and Biological Sciences 3 11%
Pharmacology, Toxicology and Pharmaceutical Science 1 4%
Other 0 0%
Unknown 7 26%