ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
Comparison of Clostridioides difficile Stool Toxin Concentrations in Adults With Symptomatic Infection and Asymptomatic Carriage Using an Ultrasensitive Quantitative Immunoassay.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Clinical significance of toxin EIA positivity in patients with suspectedJournal of clinical microbiology · 2025Pooled it
- A Laboratory Medicine Best Practices Systematic Review and Meta-analysis of Nucleic Acid Amplification Tests (NAATs) and Algorithms Including NAATs for the Diagnosis ofClinical microbiology reviews · 2019Pooled it
- CLOVER (CLOstridium difficile Vaccine Efficacy tRial) Study: A Phase 3, Randomized Trial Investigating the Efficacy and Safety of a Detoxified Toxin A/B Vaccine in Adults 50 Years and Older at Increased Risk of Clostridioides difficile Infection.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- Lab-in-a-Tube System Integrating Hierarchically Wrinkled Electrodes and DNAzyme-Functionalized Beads for Diagnosis of Clostridioides difficile Infection.Advanced materials (Deerfield Beach, Fla.) · 2026Article
- Current status and future perspectives of fecal immunological markers in the differential diagnosis of Clostridioides difficile infection in children.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Review
- Association between Clostridioides difficile Test Positivity and Colorectal Cancer Incidence in a Multisite Hospital-Based Retrospective Cohort Analysis.Cancer research communications · 2026Observational
- Modeling Clostridioides difficile toxin pathogenesis and antiserum protection in an immunocompetent intestine-on-chip platform.Scientific reports · 2026Article
- Clostridioides difficile pathogenesis and control.Nature reviews. Microbiology · 2026Review
- Clinical features of NAAT-positive, toxin-negative Clostridioides difficile infections in South Korea.The Korean journal of internal medicine · 2026Article
- Cycle thresholds and discordant 2-step testing for Clostridioides Difficile: Comparison of clinical characteristics and outcomes among discordant and true positive results.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Metagenomic analysis reveals distinct patterns of gut microbiota features with diversified functions inGut microbes · 2025Article
- Multiple cross displacement amplification (MCDA) for rapid detection of toxigenicMicrobiology spectrum · 2025Article
- Determination of the performance of a novel diagnostic test forJournal of clinical microbiology · 2025Article
- Applications of Digital Enzyme-Linked Immunosorbent Assays in Ophthalmology.Cell biochemistry and biophysics · 2025Review
- Emerging Diagnostics inInternational journal of molecular sciences · 2024Review
- Rational Design of Live Biotherapeutic Products for the Prevention ofbioRxiv : the preprint server for biology · 2024Article
- Impact of the Reverse 2-Step Algorithm forOpen forum infectious diseases · 2024Article
- Diagnostic Guidance for C. difficile Infections.Advances in experimental medicine and biology · 2024Article
- Fecal calprotectin level is nonlinearly associated with GI pathogen detection in patients with and without inflammatory bowel disease.Journal of clinical microbiology · 2023Article
- Host Immune Responses toTropical medicine and infectious disease · 2023Review
1 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 3 institutions in 3 countries.
Funding
Abstract
Background: We used an ultrasensitive, quantitative single molecule array (Simoa) immunoassay to test whether concentrations of Clostridioides (formerly Clostridium) difficile toxins A and/or B in the stool of adult inpatients with C. difficile infection (CDI) were higher than in asymptomatic carriers of toxinogenic C. difficile. Methods: Patients enrolled as CDI-NAAT had clinically significant diarrhea and a positive nucleic acid amplification test (NAAT), per US guidelines, and received CDI treatment. Potential carriers had recently received antibiotics and did not have diarrhea; positive NAAT confirmed carriage. Baseline stool samples were tested by Simoa for toxin A and B. Results: Stool toxin concentrations in both CDI-NAAT (n = 122) and carrier-NAAT (n = 44) cohorts spanned 5 logs (0 pg/mL to >100000 pg/mL). Seventy-nine of 122 (65%) CDI-NAAT and 34 of 44 (77%) carrier-NAAT had toxin A + B concentration ≥20 pg/mL (clinical cutoff). Median toxin A, toxin B, toxin A + B, and NAAT cycle threshold (Ct) values in CDI-NAAT and carrier-NAAT cohorts were similar (toxin A, 50.6 vs 60.0 pg/mL, P = .958; toxin B, 89.5 vs 42.3 pg/mL, P = .788; toxin A + B, 197.2 vs 137.3 pg/mL, P = .766; Ct, 28.1 vs 28.6, P = .354). However, when CDI/carrier cohorts were limited to those with detectable toxin, respective medians were significantly different (A: 874.0 vs 129.7, P = .021; B: 1317.0 vs 81.7, P = .003, A + B, 4180.7 vs 349.6, P = .004; Ct, 25.8 vs 27.7, P = .015). Conclusions: Toxin concentration did not differentiate an individual with CDI from one with asymptomatic carriage. Median stool toxin concentrations in groups with CDI vs carriage differed, but only when groups were defined by detectable stool toxin (vs positive NAAT).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.