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The reference method influence on the sensitivity of the Clostridium difficile enzyme immunoassays: A meta analysis

2020-06Journal article Open access
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datacite.subject.fosCiências Médicas::Outras Ciências Médicas
datacite.subject.fosCiências Naturais::Ciências Biológicas
datacite.subject.sdg08:Trabalho Digno e Crescimento Económico
datacite.subject.sdg10:Reduzir as Desigualdades
datacite.subject.sdg12:Produção e Consumo Sustentáveis
dc.contributor.authorMartins, João Paulo
dc.contributor.authorFelgueiras, Miguel
dc.contributor.authorSantos, Rui
dc.date.accessioned2025-09-11T14:23:03Z
dc.date.available2025-09-11T14:23:03Z
dc.date.issued2020-06
dc.description.abstractThe use of enzyme immunoassays to screen for toxins A and B produced by Clostridium difficile is a common procedure in algorithms designed for its detection. Moreover, the absence of a unique test capable of providing reliable results at low cost motivates a great discussion about which algorithm is the best. Thus, several studies have evaluated the performance of these enzyme immunoassays. However, all fail to provide sufficient explanations for the different behaviours observed in different studies that evaluate the same index test against a common reference method. Our main goal was to find out which factors affect the sensitivity of these assays, since the specificity is very close to 1. In this research, we verified that sensitivity increases with the prevalence rate and with the proportion of reported cases of onset diarrhea. Therefore, its use is advisable for high prevalence rates (e.g. in an epidemic setting). As far as reference methods are concerned, nucleic acid amplification tests can be used as a reference method, with a performance similar to the well-accepted toxigenic culture. The method chosen for toxigenicity screening in a toxigenic culture also seems to affect the evaluation performance of tests and should be better studied in the future.eng
dc.description.sponsorshipFunded by FCT - Fundação para a Ciência e a Tecnologia, Portugal, through the project UIDB/MAT/00006/2020.
dc.identifier.citationJoão Paulo Martins, Miguel Felgueiras, Rui Santos, The reference method influence on the sensitivity of the Clostridium difficile enzyme immunoassays: A meta analysis, Journal of Microbiological Methods, Volume 173, 2020, 105912, ISSN 0167-7012, https://doi.org/10.1016/j.mimet.2020.105912.
dc.identifier.doi10.1016/j.mimet.2020.105912
dc.identifier.eissn1872-8359
dc.identifier.issn0167-7012
dc.identifier.urihttp://hdl.handle.net/10400.8/14053
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier
dc.relation.hasversionhttps://www.sciencedirect.com/science/article/pii/S0167701219304634?via%3Dihub
dc.relation.ispartofJournal of Microbiological Methods
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectClostridium difficile
dc.subjectMeta-analysis
dc.subjectSensitivity
dc.subjectEnzyme immunoassays
dc.subjectBivariate model
dc.titleThe reference method influence on the sensitivity of the Clostridium difficile enzyme immunoassays: A meta analysiseng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleJournal of Microbiological Methods
oaire.citation.volume173
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameOliveira Martins
person.familyNameFelgueiras
person.familyNameSantos
person.givenNameJoão Paulo
person.givenNameMiguel
person.givenNameRui
person.identifier1051057
person.identifier.ciencia-id7610-8B27-8044
person.identifier.orcid0000-0002-0474-1397
person.identifier.orcid0000-0001-5450-7374
person.identifier.orcid0000-0002-7371-363X
person.identifier.ridC-1873-2015
person.identifier.scopus-author-id56979441000
relation.isAuthorOfPublicationb3dba60a-968a-47e9-87e2-b238acdbc75d
relation.isAuthorOfPublicationb7404fe1-3566-46d5-9d02-341bec92615b
relation.isAuthorOfPublicationfba82887-7d94-41f6-a4aa-06b7de054567
relation.isAuthorOfPublication.latestForDiscoveryb3dba60a-968a-47e9-87e2-b238acdbc75d

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The use of enzyme immunoassays to screen for toxins A and B produced by Clostridium difficile is a common procedure in algorithms designed for its detection. Moreover, the absence of a unique test capable of providing reliable results at low cost motivates a great discussion about which algorithm is the best. Thus, several studies have evaluated the performance of these enzyme immunoassays. However, all fail to provide sufficient explanations for the different behaviours observed in different studies that evaluate the same index test against a common reference method. Our main goal was to find out which factors affect the sensitivity of these assays, since the specificity is very close to 1. In this research, we verified that sensitivity increases with the prevalence rate and with the proportion of reported cases of onset diarrhea. Therefore, its use is advisable for high prevalence rates (e.g. in an epidemic setting). As far as reference methods are concerned, nucleic acid amplification tests can be used as a reference method, with a performance similar to the well-accepted toxigenic culture. The method chosen for toxigenicity screening in a toxigenic culture also seems to affect the evaluation performance of tests and should be better studied in the future.
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