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Kim, Kim, Kim, Koh, Kim, Jeong, Chong, and Lee: Evaluation of Rapid Assay (Tox A/B Quik Chek) for the Detection of Clostridium difficile Toxins A and B
Original Article

Korean J Clin Microbiol 2008;11(2):112-116.

Published online: 20 October 2008

DOI: https://doi.org/10.5145/kjcm.2008.11.2.112

Evaluation of Rapid Assay (Tox A/B Quik Chek) for the Detection of Clostridium difficile Toxins A and B

Sue Jung Kim1, Heejung Kim1, Myung Sook Kim1, Eunmi Koh1, Chang-Ki Kim2, Seok Hoon Jeong1, Yunsop Chong1, Kyungwon Lee1,

1Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine1, Seoul, Korea

2Korean Institute of Tuberculosis, Seoul, Korea

Correspondence: Kyungwon Lee, M.D., Department of Laboratory Medicine, Yonsei University College of Medicine, 134, Shinchondong, Seodaemun-gu, Seoul 120-752, Korea. (Tel) 82-2-2228-2446, (Fax) 82-2-313-0908, (E-mail) leekcp@yuhs.ac

Received 8 August 2008       Revised 25 September 2008

Copyright © 2008 Korean Journal of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Toxin immunoassay is widely used for rapid diagnosis of Clostridium difficile-associated diarrhea. The aim of this study was to evaluate the performance of Tox A/B Quik Chek test (TECHLAB, Blacksburg, VA, USA) compared to toxigenic culture.

Methods

From September 2006 to August 2007, 959 stools were examined by Tox A/B Quik Chek test and toxigenic culture (C. difficile culture plus tcdB PCR using colonies obtained from culture).

Results

Compared to the results of toxigenic culture, the sensitivity and specificity of Tox A/B Quik Chek test were 47.5% and 97.5%, respectively.

Conclusion

The sensitivity of Tox A/B Quik Chek test was not high, but the specificity was high. Although Tox A/B Quik Chek test alone is not sufficient to diagnose Clostridium difficile-associated diarrhea, it may aid rapid diagnosis, early treatment and prevention of nosocomial spread of the infection, if supplemented by C. difficile culture or tissue culture cytotoxin assay.

Keywords: Clostridium difficile, Enzyme immunoassay, Clostridium difficile Toxin A, Clostridium difficile Toxin B

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Table 1.
The results of Tox A/B Quik Chek test and toxigenic culture
C. difficile culture (No. tested) tcdB PCR (No. tested) Tox A/B Quik Chek
Positive Negative
Positive (105) Positive (80) 38 42
Negative (25) 0 25
Negative (854)   22 832
Total (959)   60 899
Table 2.
Comparison of Tox A/B Quik Chek test and the semiquantitative culture results in cases with toxigenic strain
Semi-quantitativ culture (No. tested) ve Tox A/B Quik Chek Odds ratio (CI 95%)∗ P value
Positive (%) Negative (%)  
Few (24) 7 (29.2) 17 (70.8) 1  
Some (10) 3 (30.0) 7 (70.0) 1.04 0.961
    (0.21∼5.23)  
Many (46) 28 (60.9) 18 (39.1) 3.78 0.014
    (1.31∼10.91)  
Total (80) 38 (47.5) 42 (52.5)    

∗ Odds ratio having a positive result in Tox A/B Quik Chek test by comparing the results of “Some” cultures to those of “Few” or the results of “Many” cultures to those of “Few”. Abbreviation: CI, confidence interval.

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