Comparison of rectal swabs and fecal samples for the detection of Clostridioides difficile infections with a new in-house PCR assay

Author:

Huletsky Ann123ORCID,Loo Vivian G.45,Longtin Yves56,Longtin Jean7,Trottier Sylvie123,Tremblay Cécile L.89,Gilca Rodica31011,Lavallée Christian91213,Brochu Éliel123,Bérubé Ève123,Bastien Martine123,Bernier Marthe123,Gagnon Martin123,Frenette Johanne123,Bestman-Smith Julie314,Deschênes Louise314,Bergeron Michel G.123

Affiliation:

1. Centre de recherche en infectiologie de l’Université Laval, Québec City, Canada

2. Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Canada

3. Axe maladies infectieuses et immunitaires, Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Canada

4. Division of Infectious Diseases, Department of Medical Microbiology, McGill University Health Centre, Montréal, Canada

5. Faculty of Medicine, McGill University, Montréal, Canada

6. Sir Mortimer B. Davis Jewish General Hospital, Montréal, Canada

7. Centre hospitalier universitaire de Québec-Université Laval, Québec City, Canada

8. Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada

9. Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Canada

10. Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec City, Canada

11. Département de risque biologique et de la santé au travail, Institut national de santé publique du Québec, Québec City, Canada

12. Service de maladies infectieuses et de microbiologie, Département de médecine spécialisée, Hôpital Maisonneuve-Rosemont - CIUSSS de l'Est-de-l'Ile-de-Montréal, Montréal, Canada

13. Département clinique de médecine de laboratoire, Centre hospitalier de l'Université de Montréal, Montréal, Canada

14. Service de microbiologie-infectiologie, Centre hospitalier universitaire de Québec-Université Laval, Québec City, Canada

Abstract

ABSTRACT The detection of Clostridioides difficile infections (CDI) relies on testing the stool of patients by toxin antigen detection or PCR methods. Although PCR and antigenic methods have significantly reduced the time to results, delays in stool collection can significantly add to the turnaround time. The use of rectal swabs to detect C. difficile could considerably reduce the time to diagnosis of CDI. We developed a new rapid PCR assay for the detection of C. difficile and evaluated this PCR assay on both stool and rectal swab specimens. We recruited a total of 623 patients suspected of C. difficile infection. Stool samples and rectal swabs were collected from each patient and tested by our PCR assay. Stool samples were also tested by the cell cytotoxicity neutralization assay (CCNA) as a reference. The PCR assay detected C. difficile in 60 stool specimens and 61 rectal swabs for the 64 patients whose stool samples were positive for C. difficile by CCNA. The PCR assay detected an additional 35 and 36 stool and rectal swab specimens positive for C. difficile , respectively, for sensitivity with stools and rectal swabs of 93.8% and 95.3%, specificity of 93.7% and 93.6%, positive predictive values of 63.2% and 62.9%, and negative predictive values of 99.2% and 99.4%. Detection of C. difficile using PCR on stools or rectal swabs yielded reliable and similar results. The use of PCR tests on rectal swabs could reduce turnaround time for CDI detection, thus improving CDI management and control of C. difficile transmission. IMPORTANCE Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, resulting in high morbidity, mortality, and economic burden. In clinical laboratories, CDI testing is currently performed on stool samples collected from patients with diarrhea. However, the diagnosis of CDI can be delayed by the time required to collect stool samples. Barriers to sample collection could be overcome by using a rectal swab instead of a stool sample. Our study showed that CDI can be identified rapidly and reliably by a new PCR assay developed in our laboratory on both stool and rectal swab specimens. The use of PCR tests on rectal swabs could reduce the time for the detection of CDI and improve the management of this infection. It should also provide a useful alternative for infection-control practitioners to better control the spread of C. difficile .

Funder

Fonds de partenariat pour un Québec innovant et en santé

GenePOC

Publisher

American Society for Microbiology

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