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Carlson TJ, Blasingame D, Gonzales-Luna AJ, Alnezary F, Garey KW. Clostridioides difficile ribotype 106: A systematic review of the antimicrobial susceptibility, genetics, and clinical outcomes of this common worldwide strain. Anaerobe 2020; 62:102142. [PMID: 32007682 PMCID: PMC7153973 DOI: 10.1016/j.anaerobe.2019.102142] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Clostridioides difficile typing is invaluable for the investigation of both institution-specific outbreaks as well as national surveillance. While the epidemic ribotype 027 (RT027) has received a significant amount of resources and attention, ribotype 106 (RT106) has become more prevalent throughout the past decade. The purpose of this systematic review was to comprehensively summarize the genetic determinants, antimicrobial susceptibility, epidemiology, and clinical outcomes of infection caused by RT106. A total of 68 articles published between 1999 and 2019 were identified as relevant to this review. Although initially identified in the United Kingdom in 1999, RT106 is now found worldwide and became the most prevalent strain in the United States in 2016. Current data indicate that RT106 harbors the tcdA and tcdB genes, lacks binary toxin genes, and does not contain any deletions in the tcdC gene, which differentiates it from other epidemic strains, including ribotypes 027 and 078. Interestingly, RT106 produces more spores than other strains, including RT027. Overall, RT106 is highly resistant to erythromycin, clindamycin, fluoroquinolones, and third-generation cephalosporins. However, the MIC90 in most studies are one to two fold dilutions below the epidemiologic cut-off values of metronidazole and vancomycin, suggesting both are acceptable treatment options from an in vitro perspective. The few clinical outcomes studies available concluded that RT106 causes less severe disease than RT027, but patients were significantly more likely to experience multiple CDI relapses when infected with a RT106 strain. Specific areas warranting future study include potential survival advantages provided by genetic elements as well as a more robust investigation of clinical outcomes associated with RT106.
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Affiliation(s)
- T J Carlson
- High Point University Fred Wilson School of Pharmacy, High Point, NC, USA
| | - D Blasingame
- The University of Houston College of Pharmacy, Houston, TX, USA
| | | | - F Alnezary
- The University of Houston College of Pharmacy, Houston, TX, USA; Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
| | - K W Garey
- The University of Houston College of Pharmacy, Houston, TX, USA.
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2
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Liu M, Wang J, Chang Y, Zhang Q, Chang D, Hui CY, Brennan JD, Li Y. In Vitro Selection of a DNA Aptamer Targeting Degraded Protein Fragments for Biosensing. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202000025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Jiayi Wang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Yangyang Chang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qiang Zhang
- School of Bioengineering Dalian University of Technology Dalian 116024 China
| | - Dingran Chang
- Department of Biochemistry and Biomedical Sciences Michael G. DeGroote Institute of Infectious Disease Research (IIDR) McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
| | - Christy Y. Hui
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - John D. Brennan
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - Yingfu Li
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
- Department of Biochemistry and Biomedical Sciences Michael G. DeGroote Institute of Infectious Disease Research (IIDR) McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
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3
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Liu M, Wang J, Chang Y, Zhang Q, Chang D, Hui CY, Brennan JD, Li Y. In Vitro Selection of a DNA Aptamer Targeting Degraded Protein Fragments for Biosensing. Angew Chem Int Ed Engl 2020; 59:7706-7710. [PMID: 32155319 DOI: 10.1002/anie.202000025] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 12/15/2022]
Abstract
Protein biomarkers often exist as degradation fragments in biological samples, and affinity agents derived using a purified protein may not recognize them, limiting their value for clinical diagnosis. Herein, we present a method to overcome this issue, by selecting aptamers against a degraded form of the toxin B protein, which is a marker for diagnosing toxigenic Clostridium difficile infections. This approach has led to isolation of a DNA aptamer that recognizes degraded toxin B, fresh toxin B, and toxin B spiked into human stool samples. DNA aptamers selected using intact recombinant toxin B failed to recognize degraded toxin B, which is the form present in stored stool samples. Using this new aptamer, we produced a simple paper-based analytical device for colorimetric detection of toxin B in stool samples, or in the NAP1 strain of Clostridium difficile. The combined aptamer-selection and paper-sensing strategy can expand the practical utility of DNA aptamers in clinical diagnosis.
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Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Jiayi Wang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Yangyang Chang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qiang Zhang
- School of Bioengineering, Dalian University of Technology, Dalian, 116024, China
| | - Dingran Chang
- Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute of Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada
| | - Christy Y Hui
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - Yingfu Li
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada.,Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute of Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada
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4
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Carroll KC, Mizusawa M. Laboratory Tests for the Diagnosis of Clostridium difficile. Clin Colon Rectal Surg 2020; 33:73-81. [PMID: 32104159 PMCID: PMC7042017 DOI: 10.1055/s-0039-3400476] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Clostridium (reclassified as " Clostridioides ") difficile is an anaerobic, gram-positive bacterium that causes significant disease through elaboration of two potent toxins in patients whose normal gut microbiota has been altered through antimicrobial or chemotherapeutic agents (dysbiosis). The optimum method of laboratory diagnosis is still somewhat controversial. Recent practice guidelines published by professional societies recommend a two-step approach beginning with a test for glutamate dehydrogenase (GDH), followed by a toxin test and/or a nucleic acid test. Alternatively, in institutions where established clinical algorithms guide testing, a nucleic acid test alone is acceptable. Nucleic acid tests are the methods of choice in approximately 50% of laboratories in the United States. These tests are considered as the most sensitive methods for detection of C. difficile in stool and are the least specific. Because of the lower specificity with nucleic acid tests, some clinicians believe that toxin enzyme immunoassays are better predictors of disease, despite their known poor performance in certain patient populations. This review will discuss the advantages and disadvantages of the currently available test methods for the diagnosis of C. difficile with a brief mention of some novel assays that are currently in clinical trials.
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Affiliation(s)
- Karen C. Carroll
- Division of Medical Microbiology, Department of Pathology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
- Address for correspondence Karen C. Carroll, MD Division of Medical Microbiology, Department of Pathology, the Johns Hopkins University School of MedicineMeyer B1-193, 600 North Wolfe Street, Baltimore MD 21287
| | - Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, Missouri
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Liu M, Yin Q, Chang Y, Zhang Q, Brennan JD, Li Y. In Vitro Selection of Circular DNA Aptamers for Biosensing Applications. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201901192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qingxin Yin
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Yangyang Chang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qiang Zhang
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
- School of Life Science and Biotechnology Dalian University of Technology Dalian 116024 China
| | - John D. Brennan
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
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6
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Liu M, Yin Q, Chang Y, Zhang Q, Brennan JD, Li Y. In Vitro Selection of Circular DNA Aptamers for Biosensing Applications. Angew Chem Int Ed Engl 2019; 58:8013-8017. [PMID: 31020784 DOI: 10.1002/anie.201901192] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/17/2019] [Indexed: 01/01/2023]
Abstract
We report on the first effort to select DNA aptamers from a circular DNA library, which resulted in the discovery of two high-affinity circular DNA aptamers that recognize the glutamate dehydrogenase (GDH) from Clostridium difficile, an established antigen for diagnosing Clostridium difficile infection (CDI). One aptamer binds effectively in both the circular and linear forms, the other is functional only in the circular configuration. Interestingly, these two aptamers recognize different epitopes on GDH, demonstrating the advantage of selecting aptamers from circular DNA libraries. A sensitive diagnostic test was developed to take advantage of the high stability of circular DNA aptamers in biological samples and their compatibility with rolling circle amplification. This test is capable of identifying patients with active CDI using stool samples. This work represents a significant step forward towards demonstrating the practical utility of DNA aptamers in clinical diagnosis.
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Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qingxin Yin
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Yangyang Chang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qiang Zhang
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada.,School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada.,Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
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Legaria MC, Rollet R, Di Martino A, Castello L, Barberis C, Rossetti MA, Guardati MC, Fernández Canigia L, Carloni G, Litterio M, Rocchi M, Anchart EG, Trejo FM, Minnaard J, Klajn D, Predari SC. Detection of toxigenic Clostridioides [Clostridium] difficile: Usefulness of two commercially available enzyme immunoassays and a PCR assay on stool samples and stool isolates. Rev Argent Microbiol 2017; 50:36-44. [PMID: 28988901 DOI: 10.1016/j.ram.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 02/07/2023] Open
Abstract
The best laboratory diagnostic approach to detect Clostridioides [Clostridium] difficile infection (CDI) is a subject of ongoing debate. With the aim of evaluating four laboratory diagnostic methods, 250 unformed stools from patients with suspected CDI submitted to nine medical center laboratories from November 2010 to December 2011, were studied using: (1) an immunochromatographic rapid assay test that combines the qualitative determination of glutamate dehydrogenase (GDH) plus toxins A and B (QAB), the CDIFF QUIK CHEK COMPLETE assay; (2) an enzyme immunoassay for qualitative determination of toxins A and B, the RIDASCREEN™ C. difficile Toxin A/B assay (RAB); (3) a PCR for the toxin B gene assay (PCR); and (4) the toxigenic culture (TC). C. difficile isolates from direct toxin negative stools by QAB, RAB and PCR were evaluated for toxigenicity by the same direct tests, in order to assess the contribution of the TC (QAB-TC, RAB-TC, PCR-TC). A combination of the cell culture cytotoxicity neutralization assay (CCCNA) in stools, and the same assay on isolates from direct negative samples (CCCNA-TC) was considered the reference method (CCCNA/CCCNA-TC). Of the 250 stools tested, 107 (42.8%) were positive by CCCNA/CCCNA-TC. The GDH and PCR/PCR-TC assays were the most sensitive, 91.59% and 87.62%, respectively. The QAB, RAB, QAB/QAB-TC and RAB/RAB-TC had the highest specificities, ca. 95%. A negative GDH result would rule out CDI, however, its low positive likelihood ratio (PLR) of 3.97 indicates that a positive result should always be complemented with the detection of toxins. If the RAB, QAB, and PCR assays do not detect toxins from direct feces, the toxigenic culture should be performed. In view of our results, the most accurate and reliable methods to be applied in a clinical microbiology laboratory were the QAB/QAB-TC, and RAB/RAB-TC, with PLRs >10 and negative likelihood ratios <0.30.
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Affiliation(s)
- María C Legaria
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital General de Agudos Dr. Enrique Tornú, CABA, Argentina.
| | - Raquel Rollet
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital de Infecciosas Dr. Francisco Javier Muñiz, CABA, Argentina
| | - Ana Di Martino
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Sanatorio de la Trinidad Mitre, CABA, Argentina
| | - Liliana Castello
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CABA, Argentina
| | - Claudia Barberis
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, CABA, Argentina
| | - María A Rossetti
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital Interzonal General de Agudos Presidente Perón, Avellaneda, Provincia de Buenos Aires, Argentina
| | - María C Guardati
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital de Emergencias Dr. Clemente Álvarez, Rosario, Provincia de Santa Fe, Argentina
| | - Liliana Fernández Canigia
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital Alemán, CABA, Argentina
| | - Graciela Carloni
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, CABA, Argentina
| | - Mirta Litterio
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Hospital Nacional de Pediatría Dr. Prof. Juan P. Garrahan, CABA, Argentina
| | - Marta Rocchi
- Hospital Nacional de Clínicas de Córdoba, Córdoba, Argentina
| | - Eduardo G Anchart
- Centro de Especialidades Médicas Ambulatorias de Rosario MH Zuasnábar (Cemar), Secretaría de Salud Pública de Rosario, Provincia de Santa Fe, Argentina
| | - Fernando M Trejo
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) - Cátedra de Microbiología Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Jessica Minnaard
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) - Cátedra de Microbiología Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Provincia de Buenos Aires, Argentina
| | - Diana Klajn
- Hospital General de Agudos Dr. Enrique Tornú, CABA, Argentina
| | - Silvia C Predari
- Subcomisión de Bacterias Anaerobias de la Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas - Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CABA, Argentina
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Liu M, Yin Q, Brennan JD, Li Y. Selection and characterization of DNA aptamers for detection of glutamate dehydrogenase from Clostridium difficile. Biochimie 2017; 145:151-157. [PMID: 28882627 DOI: 10.1016/j.biochi.2017.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/31/2017] [Indexed: 12/18/2022]
Abstract
Rapid and accurate diagnosis of Clostridium difficile infections (CDI) is crucial for patient treatment, infection control and epidemiological monitoring. As an important antigen, glutamate dehydrogenase (GDH) has been proposed as a preliminary screening test target for CDI. However, current assays based on GDH activity or GDH immunoassays have suboptimal sensitivity and specificity. Herein, we describe the selection and characterization of single-stranded DNA aptamers that specifically target GDH. After 10 rounds of selection, high-throughput sequencing was used to identify enriched aptamer candidates. Of 10 candidates, three aptamers for GDH were identified. Gel shift assays showed that these aptamers exhibited low nanomolar affinities. One aptamer was optimized based on structural analysis and further engineered into a structure-switching fluorescence signaling aptamer, wherein desorption from reduced graphene oxide (RGO) upon binding of GDH led to an increase in fluorescence emission. This method allowed for quantitative detection of GDH with a detection limit of 1 nM, providing great potential for its further application in CDI diagnosis.
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Affiliation(s)
- Meng Liu
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qingxin Yin
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - John D Brennan
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Johansson K, Karlsson H, Norén T. Clostridium difficile infection diagnostics - evaluation of the C. DIFF Quik Chek Complete assay, a rapid enzyme immunoassay for detection of toxigenic C. difficile in clinical stool samples. APMIS 2016; 124:1016-1020. [PMID: 27651167 DOI: 10.1111/apm.12595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/26/2016] [Indexed: 01/05/2023]
Abstract
Diagnostic testing for Clostridium difficile infection (CDI) has, in recent years, seen the introduction of rapid dual-EIA (enzyme immunoassay) tests combining species-specific glutamate dehydrogenase (GDH) with toxin A/B. In a prospective study, we compared the C. DIFF Quik Chek Complete test to a combination of selective culture (SC) and loop-mediated isothermal amplification (LAMP) of the toxin A gene. Of 419 specimens, 68 were positive in SC including 62 positive in LAMP (14.7%). The combined EIA yielded 82 GDH positives of which 47 were confirmed toxin A/B positive (11%) corresponding to a sensitivity and specificity of 94% for GDH EIA compared to SC and for toxin A/B EIA a sensitivity of 71% and a specificity of 99% compared to LAMP. Twenty different PCR ribotypes were evenly distributed except for UK 081 where only 25% were toxin A/B positive compared to LAMP. We propose a primary use of a combined GDH toxin A/B EIA permitting a sensitive 1-h result of 379 of 419 (90%, all negatives plus GDH and toxin EIA positives) referred specimens. The remaining 10% being GDH positive should be tested for toxin A/B gene on the same day and positive results left to a final decision by the physician.
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Affiliation(s)
- Karin Johansson
- Department of Laboratory Medicine, Molecular Diagnostics, Örebro University Hospital, Örebro, Sweden.
| | - Hanna Karlsson
- Department of Laboratory Medicine, Molecular Diagnostics, Örebro University Hospital, Örebro, Sweden
| | - Torbjörn Norén
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Carson KC, Riley TV. Comparison of the Vidas C. difficile and Quik Chek-60 glutamate dehydrogenase assays for the detection of Clostridium difficile in faecal samples. Pathology 2016; 48:506-8. [PMID: 27311869 DOI: 10.1016/j.pathol.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Kerry C Carson
- Department of Microbiology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - Thomas V Riley
- Department of Microbiology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia.
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11
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Evaluation of the VIDAS glutamate dehydrogenase assay for the detection of Clostridium difficile. Anaerobe 2016; 40:68-72. [PMID: 27282799 DOI: 10.1016/j.anaerobe.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 12/19/2022]
Abstract
We evaluated the performance of the VIDAS GDH assay for the detection of Clostridium difficile. In total, 350 fecal specimens collected from patients clinically suspected of having CDI were analyzed by C. difficile culture and enzyme-linked fluorescent immunoassay (VIDAS GDH); the results were compared with those of toxigenic C. difficile culture (TC), PCR (Xpert C. difficile assay), and toxin AB EIA (VIDAS CDAB). The numbers of culture-positive and culture-negative samples were 108 and 242, respectively. The concordance between the GDH assay and C. difficile culture was 90.3%. With PCR, 12 more samples were found to be positive in GDH-positive/C. difficile culture-negative specimens. Thus, the concordance between GDH assay and C. difficile culture/PCR was 93.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of the VIDAS GDH assay were 97.2%, 87.2%, 77.2%, and 98.6%, respectively, based on the C. difficile culture, and 97.5%, 91.7%, 86.0%, and 98.6%, respectively, based on C. difficile culture/PCR. Positivity rates of the GDH assay were partially associated with those of semi-quantitative C. difficile cultures, which were maximized in grade 3 (>100 colony-forming unit [CFU]) compared with grade 1 (<10 CFU). We evaluated the two-step or three-step algorithm using GDH assay as a first step. No toxin EIA-positive case was found among GDH-negative samples, and 60.8% (48/79) were TC- and/or PCR-positive among the GDH-positive/toxin EIA-negative samples. Thus, approximately 25% of the 350 samples required a confirmatory test (TC or PCR) in the GDH-toxin EIA algorithm, whereas only 2.3% of the total samples in GDH-PCR algorithm was discrepant and required another confirmatory test like TC.
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12
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Molecular Diagnostics for Clostridium difficile. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Planche T, Wilcox MH. Diagnostic Pitfalls in Clostridium difficile Infection. Infect Dis Clin North Am 2015; 29:63-82. [DOI: 10.1016/j.idc.2014.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Diagnosis of Clostridium difficile: real-time PCR detection of toxin genes in faecal samples is more sensitive compared to toxigenic culture. Eur J Clin Microbiol Infect Dis 2014; 34:727-36. [DOI: 10.1007/s10096-014-2284-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
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16
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Comparison of GenomEra C. difficile and Xpert C. difficile as confirmatory tests in a multistep algorithm for diagnosis of Clostridium difficile infection. J Clin Microbiol 2014; 53:332-5. [PMID: 25392360 DOI: 10.1128/jcm.03093-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We compared two multistep diagnostic algorithms based on C. Diff Quik Chek Complete and, as confirmatory tests, GenomEra C. difficile and Xpert C. difficile. The sensitivity, specificity, positive predictive value, and negative predictive value were 87.2%, 99.7%, 97.1%, and 98.3%, respectively, for the GenomEra-based algorithm and 89.7%, 99.4%, 95.5%, and 98.6%, respectively, for the Xpert-based algorithm. GenomEra represents an alternative to Xpert as a confirmatory test of a multistep algorithm for Clostridium difficile infection (CDI) diagnosis.
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17
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Eckert C, Jones G, Barbut F. Diagnosis of Clostridium difficile infection: the molecular approach. Future Microbiol 2014; 8:1587-98. [PMID: 24266358 DOI: 10.2217/fmb.13.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Diagnosis of Clostridium difficile infection is based on clinical presentation and laboratory tests. Although numerous laboratory methods are now available, the diagnosis of C. difficile infection remains challenging. Nucleic acid amplification tests (NAATs) are the most recent marketed methods. These methods detect genes for toxins A and/or B. They are very sensitive compared with the reference method (toxigenic culture) and are thus very promising, despite their cost. However, a positive NAAT result must be interpreted with caution owing to the possible detection of asymptomatic carriers of toxigenic strains who may have diarrhea for other reasons. The place of NAATs in current diagnostic strategies needs to be better defined, but the rapidity of the result is interesting for early recognition of the disease.
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Affiliation(s)
- Catherine Eckert
- National Reference Laboratory for Clostridium difficile, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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18
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Kim H, Kim WH, Kim M, Jeong SH, Lee K. Evaluation of a rapid membrane enzyme immunoassay for the simultaneous detection of glutamate dehydrogenase and toxin for the diagnosis of Clostridium difficile infection. Ann Lab Med 2014; 34:235-9. [PMID: 24790912 PMCID: PMC3999323 DOI: 10.3343/alm.2014.34.3.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/14/2013] [Accepted: 03/03/2014] [Indexed: 12/15/2022] Open
Abstract
We evaluated the new C. DIFF QUIK CHEK COMPLETE (CD COMPLETE; TechLab, USA), which is a rapid membrane enzyme immunoassay that uses a combination of glutamate dehydrogenase (GDH) antigen and toxin A and B detection. A total of 608 consecutive loose stool specimens collected from the patients with suspected Clostridium difficile infection (CDI) from August to December 2012 were subjected to the CD COMPLETE and VIDAS Clostridium difficile A & B (VIDAS CDAB; bioMérieux, France). Their performances were compared with a toxigenic culture as a reference. Stool specimens that were culture-negative and CD COMPLETE- or VIDAS CDAB-positive were analyzed by using an enrichment procedure. In comparison to the toxigenic cultures, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were 63.6%, 98.0%, 76.1%, and 96.4%, respectively, for the CD COMPLETE-toxin and 75.5%, 97.4%, 72.5%, and 97.8%, respectively, for the VIDAS CDAB. In comparison to the enriched C. difficile cultures, the sensitivity, specificity, PPV, and NPV for the CD COMPLETE-GDH were 91.0%, 92.4%, 70.5%, and 98.1%, respectively. The CD COMPLETE is a reliable method for the diagnosis of CDI and provides greater sensitivity than toxin enzyme immunoassay alone. Furthermore, the CD COMPLETE-GDH has advantages over direct culture in detecting C. difficile.
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Affiliation(s)
- Heejung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Hee Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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19
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Premarket evaluations of the IMDx C. difficile for Abbott m2000 Assay and the BD Max Cdiff Assay. J Clin Microbiol 2014; 52:1423-8. [PMID: 24554744 DOI: 10.1128/jcm.03293-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Clostridium difficile-associated diarrhea is a well-recognized complication of antibiotic use. Historically, diagnosing C. difficile has been difficult, as antigen assays are insensitive and culture-based methods require several days to yield results. Nucleic acid amplification tests (NAATs) are quickly becoming the standard of care. We compared the performance of two automated investigational/research use only (IUO/RUO) NAATs for the detection of C. difficile toxin genes, the IMDx C. difficile for Abbott m2000 Assay (IMDx) and the BD Max Cdiff Assay (Max). A prospective analysis of 111 stool specimens received in the laboratory for C. difficile testing by the laboratory's test of record (TOR), the BD GeneOhm Cdiff Assay, and a retrospective analysis of 88 specimens previously determined to be positive for C. difficile were included in the study. One prospective specimen was excluded due to loss to follow-up discrepancy analysis. Of the remaining 198 specimens, 90 were positive by all three methods, 9 were positive by TOR and Max, and 3 were positive by TOR only. One negative specimen was initially inhibitory by Max. The remaining 95 specimens were negative by all methods. Toxigenic C. difficile culture was performed on the 12 discrepant samples. True C. difficile-positive status was defined as either positive by all three amplification assays or positive by toxigenic culture. Based on this definition, the sensitivity and specificity were 96.9% and 95% for Max and 92.8% and 100% for IMDx. In summary, both highly automated systems demonstrated excellent performance, and each has individual benefits, which will ensure that they will both have a niche in clinical laboratories.
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20
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Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2014; 26:604-30. [PMID: 23824374 DOI: 10.1128/cmr.00016-13] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.
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Correlation between Clostridium difficile bacterial load, commercial real-time PCR cycle thresholds, and results of diagnostic tests based on enzyme immunoassay and cell culture cytotoxicity assay. J Clin Microbiol 2013; 51:3624-30. [PMID: 23966497 DOI: 10.1128/jcm.01444-13] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The impact of Clostridium difficile fecal loads on diagnostic test results is poorly understood, but it may have clinical importance. In this study, we investigated the relationship between C. difficile fecal load and the results of four assays: a glutamate dehydrogenase (GDH) enzyme immunoassay (EIA), a toxin A/B antigen EIA (ToxAB), a cell culture cytotoxicity assay (CCA), and PCR targeting the tcdB gene. We also compared the PCR cycle threshold (CT) with the results of quantitative culture using Spearman's rank correlation coefficient. Finally, we sequenced the genomes of 24 strains with different detection profiles. A total of 203 clinical samples harboring toxigenic C. difficile were analyzed and sorted into one of four groups: 17 PCR(+) (group 1), 37 PCR(+) GDH(+) (group 2), 24 PCR(+) GDH(+) CCA(+) (group 3), and 125 PCR(+) GDH(+) ToxAB(+) (group 4). The overall median fecal load in log10 CFU/g was 6.67 (interquartile range [IQR], 5.57 to 7.54). The median fecal bacterial load of groups 1, 2, 3, and 4 were 4.15 (IQR, 3.00 to 4.98), 5.74 (IQR, 4.75 to 6.16), 6.20 (IQR, 5.23 to 6.80), and 7.08 (IQR, 6.35 to 7.83), respectively. Group 1 samples had lower fecal loads than those from each of the other groups (P < 0.001). Group 2 samples had lower fecal loads than those from groups 3 and 4 (P < 0.001). There was a significant correlation between PCR CT and fecal loads (ρ = -0.697; P < 0.001). NAP1 strains were associated with the detection of toxins by EIA or CCA (P = 0.041). This study demonstrates an association between C. difficile fecal load and the results of routinely used diagnostic tests.
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Freifeld AG, Simonsen KA, Booth CS, Zhao X, Whitney SE, Karre T, Iwen PC, Viljoen HJ. A new rapid method for Clostridium difficile DNA extraction and detection in stool: toward point-of-care diagnostic testing. J Mol Diagn 2012; 14:274-9. [PMID: 22402170 DOI: 10.1016/j.jmoldx.2012.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 01/04/2012] [Accepted: 01/18/2012] [Indexed: 02/04/2023] Open
Abstract
We describe a new method for the rapid diagnosis of Clostridium difficile infection, with stool sample preparation and DNA extraction by heat and physical disruption in a single-use lysis microreactor (LMR), followed by a rapid PCR amplification step. All steps can be accomplished in <20 minutes overall. Gel electrophoresis is currently used to detect the amplification product, pending real-time availability with an ultra-rapid thermocycler. Compared with the dual enzyme immunoassay (EIA) screening test (C. diff Quik Chek Complete; Techlab, Blacksburg, VA), the novel LMR/PCR assay showed complete concordance with all glutamate dehydrogenase (GDH) results (GDH(+)/toxin(+), n = 48; GDH(-)/toxin(-), n = 81). All 69 stool samples with discordant EIA results (GDH(+)/toxin(-)) were tested by both the LMR/PCR assay and the loop-mediated isothermal amplification test (LAMP) (Illumigene C. difficile; Meridian Bioscience, Cincinnati, OH). In 64/69 EIA-discordant samples, LAMP and LMR/PCR results matched (both positive in 29 sample and both negative in 35 samples); in the remaining 5 samples, results were discrepant between the LAMP assay (all five negative) and the LMR/PCR assay (all 5 positive). Overall, LMR/PCR testing matched the current algorithm of EIA and/or LAMP reflex testing in 193/198 (97.5%) samples. The present proof-of-concept study suggests that the novel LMR/PCR technique described here may be developed as an inexpensive, rapid, and reliable point-of-care diagnostic test for C. difficile infection and other infectious diseases.
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Affiliation(s)
- Alison G Freifeld
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Glutamate dehydrogenase is highly conserved among Clostridium difficile ribotypes. J Clin Microbiol 2012; 50:1425-6. [PMID: 22301027 DOI: 10.1128/jcm.05600-11] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
gluD was highly conserved and glutamate dehydrogenase (GDH) was readily expressed in vitro by all 77 Clostridium difficile ribotypes assayed. All ribotypes, including ARL 002, ARL 027, and ARL 106, were reactive in assays that detect C. difficile GDH.
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