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J Clin Microbiol. 2006 Mar;44(3):1145-9.

Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin.

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  • 1Division of Medical Microbiology, The Johns Hopkins Hospital/Meyer B1-193, 600 North Wolfe St., Baltimore, Maryland 21287-7093, USA.


We evaluated a two-step algorithm for detecting toxigenic Clostridium difficile: an enzyme immunoassay for glutamate dehydrogenase antigen (Ag-EIA) and then, for antigen-positive specimens, a concurrent cell culture cytotoxicity neutralization assay (CCNA). Antigen-negative results were > or = 99% predictive of CCNA negativity. Because the Ag-EIA reduced cell culture workload by approximately 75 to 80% and two-step testing was complete in < or = 3 days, we decided that this algorithm would be effective. Over 6 months, our laboratories' expenses were US dollar 143,000 less than if CCNA alone had been performed on all 5,887 specimens.

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