Recent evidence shows that patients asymptomatically colonized with Clostridium difficile may contribute to the transmission of C. Difficile in health care facilities. Additionally, these patients may have a higher risk of developing C. Difficile infection. The aim of this study was to compare a commercially available PCR directed to both toxin A and B (artus C. Difficile QS-RGQ kit CE; Qiagen), an enzymelinked fluorescent assay to glutamate dehydrogenase (GDH ELFA) (Vidas, bioMérieux), and an in-house-developed PCR to tcdB, with (toxigenic) culture of C. Difficile as the gold standard to detect asymptomatic colonization. Test performances were evaluated in a collection of 765 stool samples obtained from asymptomatic patients at admission to the hospital. The C. Difficile prevalence in this collection was 5.1%, and 3.1% contained toxigenic C. Difficile. Compared to C. Difficile culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C. Difficile GDH ELFA were 87.2%, 91.2%, 34.7%, and 99.3%, respectively. Compared with results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of the commercially available PCR and the in-house PCR were 95.8%, 93.4%, 31.9%, 99.9%, and 87.5%, 98.8%, 70%, and 99.6%, respectively. We conclude that in a lowprevalence setting of asymptomatically colonized patients, both GDH ELFA and a nucleic acid amplification test can be applied as a first screening test, as they both display a high NPV. However, the low PPV of the tests hinders the use of these assays as stand-alone tests.

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Keywords Asymptomatic, Carrier, Clostridium difficile, Diagnostics
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Journal Journal of Clinical Microbiology
Terveer, E.M, Crobach, S, Sanders, I.M.J.G. (Ingrid M.J.G.), Vos, M.C, Verduin, C.M, & Kuijper, E. (2017). Detection of clostridium difficile in feces of asymptomatic patients admitted to the hospital. Journal of Clinical Microbiology, 55(2), 403–411. doi:10.1128/JCM.01858-16