False Negative Results in Clostridium difficile Testing.
BACKGROUND
Accurate diagnosis of Clostridium difficile infection (CDI) is paramount for patient management. The wrong diagnosis places patients at risk, delays treatment, and/ or contributes to transmission of infection in the healthcare setting. Although amplification of the toxin B gene by polymerase chain reaction (PCR) is a sensitive method for detecting toxigenic C. difficile, false negative results still occur and could impact the diagnosis and treatment of this infection.


METHODS
This study investigated 48 patients that tested negative for toxigenic C. difficile via GeneXpert C. difficile epi test, while simultaneously testing positive for toxigenic C. difficile via stool culture. Fifty discrepant samples were collected over a 15-month period and all C. difficile isolates were characterized by ribotype. Patient charts were reviewed to assess whether discrepant results impacted the treatment course or clinical outcome of affected patients.


RESULTS
Fifty samples of a total of 2308 samples tested in an acute healthcare facility over a 15-month period had negative PCR and positive stool culture for toxigenic C. difficile. C. difficile isolated from the discrepant samples resulted in diverse ribotyping patterns suggesting they were derived from different strains. The samples belonged to patients who were distributed evenly between age groups and wards in the hospital. In the majority of cases, the false negative C. difficile test results did not seem to impact the clinical outcome in these patients.


CONCLUSIONS
The PCR limit of detection may impact the results of molecular methods for C. difficile detection. Both clinical and analytical sensitivity of C. difficile tests should be considered when deciding which diagnostic assay to use, and clinical correlates should be examined carefully before excluding CDI as a cause of disease.
['Murad|Yanal M|YM|', 'Perez|Justo|J|', 'Ybazeta|Gustavo|G|', 'Mavin|Sarah|S|', 'Lefebvre|Sebastien|S|', 'Weese|J Scott|JS|', 'Rousseau|Joyce|J|', 'Diaz-Mitoma|Francisco|F|', 'Nokhbeh|Reza|R|']
D001426:Bacterial Proteins D001427:Bacterial Toxins D016360:Clostridioides difficile D003015:Clostridium Infections D004768:Enterotoxins D005188:False Negative Reactions D005243:Feces D006801:Humans D060885:Multiplex Polymerase Chain Reaction D011933:Reagent Kits, Diagnostic D021521:Ribotyping
False negative Clostridium difficile Molecular testing