THE ROLE OF THE FAECAL SAMPLES CULTIVATION IN THE DIAGNOSTICS OF CLOSTRIDIOIDES DIFFICILE INFECTION

Kiril Mihajlov; Elena Trajkovska Dokic; Liljana Labachevska Gjatovska; Marko Kostovski; Radomir Jovchevski; Danica Kovacheva-Trpkovska; Biljana Cvetanovska Ilievski; Nadica Krsteva; Kristijan Dimitrievski

Kiril Mihajlov Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Elena Trajkovska Dokic Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Liljana Labachevska Gjatovska Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Marko Kostovski Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Radomir Jovchevski Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Danica Kovacheva-Trpkovska Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Biljana Cvetanovska Ilievski University Surgery Clinic “St. Naum of Ohrid”, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Nadica Krsteva Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Kristijan Dimitrievski Institute of Microbiology and Parasitology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

Abstract

Introduction: Clostridioides difficile is one of the most important intra-hospital pathogens. A few years ago, a new diagnostic algorithm for Clostridioides difficile infection (CDI) was introduced by ESCMID, stating that cultivation of the bacteria is not necessary for the diagnosis of CDI. Aim: We aimed to explore the role of the cultivation of faecal samples in the diagnosis of CDI. Materials and Methods: In 4 years, we have cultivated 80 different strains of C. difficile from as many patients. Initially, 1380 faecal samples from CDI-suspected patients were planted on selective and non-selective blood agar media and were accordingly incubated in order to isolate the strains. Quick immuno-chromatographic tests were performed on each faecal sample for detection of GDH (glutamate dehydrogenase) and C. difficile toxins A and B as well as on each confirmed C. difficile isolate (from one colony-toxins detection only). Results: In 14 of the 80 faecal samples from which the isolates originated, toxins A and B have not been detected. In 8 of these 14 strains, toxins A and B were detected only from the culture. Only 6 strains were confirmed as non-toxigenic. Conclusions: Although there was no statistical significance, the detection rate of C. difficile toxins A and B was higher from the culture than from the faecal samples by up to 10%. Cultivation of the samples for C. difficile could reduce the rate of false negative findings for CDI.

Keywords: Clostridioides difficile infection, ESCMID diagnostic algorithm, toxigenic culture.

References

1.Voth DE, Ballard JD. Clostridium difficile toxins mechanism of action and role in disease. Clin Microbiol Rev. 2005;18:247-263.
2.Crobach MJT, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM, Wilcox MH, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016;22:S63-S81.
3.Freeman J, Wilcox MH. Effects of storage conditions on viability of Clostridium difficile vegetative cells and spores and toxin activity in human faeces. J Clin Pathol. 2003;56:126-128.
4.Mihajlov K, Trajkovska Dokic E, Labachevska Gjatovska L, Kostovski M, Jovchevski R, Kovacheva Trpkovska D, Ignjatovikj Mihajlova I. Antibiotics cure and risk factor for Clostridioides difficile infection. Acad Med J. 2024;4(1):41-47.
5.Mihajlov K, Grdanoska T, Trajkovska Dokic E. Distribution of Clostridioides difficile ribotypes isolated from patients in North Macedonia update. Acad Med J. 2023;3:32-40.
6.Cohen S, Gerding D, Johnson S, Kelly C, Loo V, McDonald L, Wilcox M. Clinical practice guidelines for Clostridium difficile infection in adults 2010 update by SHEA and IDSA. Infect Control Hosp Epidemiol. 2010;31(5):431-455.
7.Planche TD, Davies KA, Coen PG, Finney JM, Monahan IM, Morris KA, et al. Differences in outcome according to Clostridium difficile testing method a prospective multicentre diagnostic validation study. Lancet Infect Dis. 2013;13:936-945.
8.Davies KA, Ashwin H, Longshaw CM, Burns A, Davis L, Wilcox H. Diversity of Clostridium difficile PCR ribotypes in Europe results from the European multicentre prospective biannual point-prevalence study EUCLID 2012–2013. Euro Surveill. 2016;21(29).
9.Imwattana K, Knight D, Kullin B, Collins D, Putsathit P, Kiratisin P, Riley T. Clostridium difficile ribotype 017 characterization evolution and epidemiology of the dominant strain in Asia. Emerg Microbes Infect. 2019;8:796-807.