The reported results only partially agree with our previously published study, which surveyed 63 doctors and 79 nurses.1 In our true/false questionnaire, the statement ‘Clostridium difficile can cause multiple syndromes, one of which is pseudomembranous colitis’ was identified as correct by 92% and 94% of nurses and doctors, respectively. We are concerned that Aroori et al. stated that the only correct answer to Question 7 (‘Which of the following conditions may be due to C. difficile infection (CDI)?’) was ‘toxic mega-colon’. It is widely acknowledged that pseudomembranous colitis and antibiotic-associated colitis may also be due to CDI.
Clarification of Question 13 about the gold-standard test for identification of pathogenic CDI is also needed. The answer given was ‘cytotoxin assay for detecting cytotoxin B’. The gold-standard test for CDI according to the Health Protection Agency is a cell culture based method,2 whereby cytopathic effect (CPE) is observed after overnight culture of stool in a monkey verocell sheet assay, and neutralisation of any CPE observed with specific anti-sera. This detects both toxins A and B, and should not be confused with the most common tests (enzyme immuno assays or ELISAs) used to detect C. difficile toxins. There are advantages and disadvantages with both methods,2 and many laboratories are now adopting a two-step testing procedure.2,3 At our hospital, we perform an immediate EIA and aim to issue any reactive results within 4 h, and then proceed to confirmation by overnight detection of CPE in cell-culture.
Therefore, we take issue with the conclusion that there is a significant lack of knowledge concerning CDI among healthcare professionals, in particular nurses and consultants. Undoubtedly, as the epidemiology of CDI is changing, education of hospital staff should be continuous, and adequately updated.
References
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