Diagnosis of Clostridioides difficile infection by analysis of volatile organic compounds in breath, plasma, and stool: A cross-sectional proof-of-concept study

PLoS One. 2021 Aug 18;16(8):e0256259. doi: 10.1371/journal.pone.0256259. eCollection 2021.

Abstract

Clostridioides difficile infection (CDI) is an important infectious cause of antibiotic-associated diarrhea, with significant morbidity and mortality. Current diagnostic algorithms are based on identifying toxin by enzyme immunoassay (EIA) and toxin gene by real-time polymerase chain reaction (PCR) in patients with diarrhea. EIA's sensitivity is poor, and PCR, although highly sensitive and specific, cannot differentiate infection from colonization. An ideal test that incorporates microbial factors, host factors, and host-microbe interaction might characterize true infection, and assess prognosis and recurrence. The study of volatile organic compounds (VOCs) has the potential to be an ideal diagnostic test. The presence of VOCs accounts for the characteristic odor of stool in CDI but their presence in breath and plasma has not been studied yet. A cross-sectional proof-of-concept study analyzing VOCs using selected ion flow tube mass spectrometry (SIFT-MS) was done on breath, stool, and plasma of patients with clinical features and positive PCR for CDI (cases) and compared with patients with clinical features but a negative PCR (control). Our results showed that VOC patterns in breath, stool, and plasma, had good accuracy [area under the receiver operating characteristic curve (ROC) 93%, 86%, and 91%, respectively] for identifying patients with CDI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Biomarkers / analysis
  • Breath Tests / methods*
  • Clostridioides difficile / growth & development
  • Clostridioides difficile / metabolism*
  • Clostridioides difficile / pathogenicity
  • Clostridium Infections / diagnosis*
  • Clostridium Infections / metabolism
  • Clostridium Infections / microbiology
  • Cross-Sectional Studies
  • Diarrhea / diagnosis*
  • Diarrhea / metabolism
  • Diarrhea / microbiology
  • Exhalation
  • Feces / chemistry
  • Feces / microbiology
  • Female
  • Humans
  • Male
  • Mass Spectrometry / instrumentation
  • Mass Spectrometry / methods*
  • Middle Aged
  • Proof of Concept Study
  • ROC Curve
  • Volatile Organic Compounds / analysis*

Substances

  • Biomarkers
  • Volatile Organic Compounds

Grants and funding

This research was supported by Cleveland Clinic Lerner Research Institute Research Program Committee grant (grant number: 290, awarded to Teny M. John, March 13, 2018) The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.