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J Med Microbiol 54 (2005), 187-191; DOI: 10.1099/jmm.0.45844-0
© 2005 Society for General Microbiology
ISSN 0022-2615

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Michel Delmée, Johan Van Broeck, Anne Simon, Michèle Janssens and Véronique Avesani

Université Catholique de Louvain, Microbiology Unit, Avenue Hippocrate, 54.90, B-1200 Brussels, Belgium

Correspondence Michel Delmée delmee{at}mblg.ucl.ac.be

Received July 28, 2004
Accepted August 27, 2004

A routine protocol for diagnosing Clostridium difficile-associated diarrhoea (CDAD) based on both faecal-cytotoxin detection and toxigenic culture was adopted by the microbiology laboratory of the St Luc-UCL University Hospital in Brussels in 1997. A toxigenic culture is a faecal culture followed, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production. The results obtained over the past 7 years in the hospital are reviewed here. A total of 10 552 diarrhoeal stools from 7042 patients were analysed, of which 9494 were negative for all tests. A total of 1058 samples (10 %) from 794 patients were culture-positive, of which 460 (4.4 %) were positive for a faecal cytotoxin. The remaining 598 cultures were tested for toxin A on colonies; 355 of them were positive, which is 3.4 % of the total, and the remaining 243 (2.3 %) were negative. The positivity of the faecal-cytotoxin assay was statistically linked to the number of colonies observed on the culture plate. In conclusion, over a 7 year period, toxigenic culture allowed the diagnosis of 355 cases of CDAD that would have been missed by a protocol using a faecal-cytotoxin assay alone. In terms of both patient care, prevention of environmental contamination and prevention of risk of a hospital outbreak, it is proposed that these results justify the recommendation to perform both faecal-toxin assay and culture in routine medical practice.

This paper was presented in part at the First International Clostridium difficile Symposium, Kranjska Gora, Slovenia, 5–7 May 2004.

Abbreviations: CDAD, Clostridium difficile-associated disease; IA, immunoassay.




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