Skip to main content
×
Home
    • Aa
    • Aa

High Proportion of False-Positive Clostridium difficile Enzyme Immunoassays for Toxin A and B in Pediatric Patients

  • Philip Toltzis (a1), Michelle M. Nerandzic (a2), Elie Saade (a2), Mary Ann O'Riordan (a1), Sarah Smathers (a3), Theoklis Zaoutis (a3), Jason Kim (a3) and Curtis J. Donskey (a4)...
Abstract
Objectives.

To determine the frequency of false-positive Clostridium difficile toxin enzyme immunoassay (EIA) results in hospitalized children and to examine potential reasons for this false positivity.

Design.

Nested case-control.

Setting.

Two tertiary care pediatric hospitals.

Methods.

As part of a natural history study, prospectively collected EIA-positive stools were cultured for toxigenic C. difficile, and characteristics of children with false-positive and true-positive EIA results were compared. EIA-positive/culture-negative samples were recultured after dilution and enrichment steps, were evaluated for presence of the tcdB gene by polymerase chain reaction (PCR), and were further cultured for Clostridium sordellii, a cause of false-positive EIA toxin assays.

Results.

Of 112 EIA-positive stools cultured, 72 grew toxigenic C. difficile and 40 did not, indicating a positive predictive value of 64% in this population. The estimated prevalence of C. difficile infection (CDI) in the study sites among children tested for this pathogen was 5%–7%. Children with false-positive EIA results were significantly younger than those with true-positive tests but did not differ in other characteristics. No false-positive specimens yielded C. difficile when cultured after enrichment or serial dilution, 1 specimen was positive for tcdB by PCR, and none grew C. sordellii.

Conclusions.

Approximately one-third of EIA tests used to evaluate pediatric inpatients for CDI were falsely positive. This finding was likely due to the low prevalence of CDI in pediatric hospitals, which diminishes the test's positive predictive value. These data raise concerns about the use of EIA assays to diagnosis CDI in children.

Infect Control Hosp Epidemiol 2012;33(2):175-179

Copyright
Corresponding author
Division of Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106 (pxt2@case.edu)
References
Hide All
1. LC McDonald , GE Killgore , A Thompson , et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.

2. J Kim , SA Smathers , P Prasad , KH Leckerman , S Coffin , T Zaoutis . Epidemiological features of Clostridium difficile–associated disease among inpatients at children's hospitals in the United States, 2001–2006. Pediatrics 2008;122:12661270.

3. CM Nylund , A Goudie , JM Garza , G Fairbrother , MB Cohen . Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011;165:451457.

4. MD Zilberberg , GS Tillotson , C McDonald . Clostridium difficile infections among hospitalized children, United States, 1997–2006. Emerg Infect Dis 2010;16:604609.

5. VG Loo , L Poirier , MA Miller , et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.

9. LR Peterson , A Robicsek . Does my patient have Clostridium difficile infection? Ann Intern Med 2009;151:176179.

11. MM Nerandzic , CJ Donskey . Effective and reduced-cost modified selective medium for isolation of Clostridium difficile. J Clin Microbiol 2009;47:397400.

12. MJ Aldape , AE Bryant , DL Stevens . Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment. Clin Infect Dis 2006;43:14361446.

16. HE Larson , FE Barclay , P Honour , ID Hill . Epidemiology of Clostridium difficile in infants. J Infect Dis 1982;146:727733.

17. RJ Sherertz , FA Sarubbi . The prevalence of Clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group. J Pediatr 1982;100:435439.

19. DM Cardona , KH Rand . Evaluation of repeat Clostridium difficile enzyme immunoassay testing. J Clin Microbiol 2008;46:36863689.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 127 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th October 2017. This data will be updated every 24 hours.