<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0016-3813</journal-id>
<journal-title><![CDATA[Gaceta médica de México]]></journal-title>
<abbrev-journal-title><![CDATA[Gac. Méd. Méx]]></abbrev-journal-title>
<issn>0016-3813</issn>
<publisher>
<publisher-name><![CDATA[Academia Nacional de Medicina de México A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0016-38132021000100113</article-id>
<article-id pub-id-type="doi">10.24875/gmm.20000106</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[¿La detección de toxinas de Clostridioides difficile es necesaria cuando se detecta la enzima glutamato deshidrogenasa?]]></article-title>
<article-title xml:lang="en"><![CDATA[Is Clostridioides difficile toxins detection necessary when the glutamate dehydrogenase enzyme is detected?]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Fuentes]]></surname>
<given-names><![CDATA[José F.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torres-Murillo]]></surname>
<given-names><![CDATA[Brenda J.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguilar-Orozco]]></surname>
<given-names><![CDATA[Gilberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Élida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mosqueda]]></surname>
<given-names><![CDATA[Juan L.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Macías]]></surname>
<given-names><![CDATA[Alejandro E.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Álvarez]]></surname>
<given-names><![CDATA[José A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Guanajuato Departamento de Medicina y Nutrición ]]></institution>
<addr-line><![CDATA[Guanajuato ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Aranda de la Parra  ]]></institution>
<addr-line><![CDATA[Guanajuato ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2021</year>
</pub-date>
<volume>157</volume>
<numero>1</numero>
<fpage>113</fpage>
<lpage>115</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0016-38132021000100113&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0016-38132021000100113&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0016-38132021000100113&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: Clostridioides difficile causa diarrea y colitis pseudomembranosa. Su diagnóstico se realiza con la detección de glutamato-deshidrogenasa (GDH) o las toxinas A y B y se confirma con pruebas de amplificación de ácidos nucleicos.  Objetivo: Definir si la determinación de GDH es redundante a la de las toxinas.  Métodos: Estudio observacional retrospectivo de muestras fecales de pacientes con sospecha de infección por Clostridioides difficile. Las toxinas y GDH se determinaron mediante inmunocromatografía. Se realizó una simulación bayesiana con los cocientes de probabilidad; se consideró significativo un valor de p &lt; 0.05.  Resultados: Se analizaron 329 resultados de GDH y toxinas A y B. Se encontró una prevalencia de infección de Clostridioides difficile de 18.2 %. La sensibilidad y especificidad de la prueba de GDH fue de 0.90 y 0.89, respectivamente. El cociente de probabilidad positivo fue de 8.9 y el negativo, de 0.11.  Conclusiones: Un resultado negativo de GDH disminuye considerablemente la probabilidad de infección, pero no la descarta. La detección de toxinas de Clostridioides difficile puede ser necesaria en instituciones donde la amplificación de ácidos nucleicos no es económica o accesible.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Clostridioides difficile causes diarrhea and pseudomembranous colitis. Its diagnosis is made with glutamate dehydrogenase (GDH) or toxins A and B detection and is confirmed with nucleic acid amplification tests.  Objective: To define if GDH determination is redundant to that of toxins.  Methods: Retrospective, observational study in diarrheal stools of patients with suspected Clostridioides difficile infection. Toxins and GDH were determined by immunochromatography. Bayesian simulation was performed with likelihood ratios; a p-value &lt; 0.05 was regarded as significant.  Results: 329 GDH and toxin A and B results were analyzed. Clostridioides difficile infection prevalence was 18.2 %. Sensitivity and specificity of the GDH test were 0.90 and 0.89, respectively. Positive likelihood ratio was 8.9, and negative was 0.11.  Conclusions: A negative GDH result considerably reduces the probability of infection but does not rule it out. Clostridioides difficile toxins detection may be necessary in institutions where nucleic acid amplification is not affordable or accessible.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Clostridioides difficile]]></kwd>
<kwd lng="es"><![CDATA[Glutamato deshidrogenasa]]></kwd>
<kwd lng="es"><![CDATA[Toxina A]]></kwd>
<kwd lng="es"><![CDATA[Toxina B]]></kwd>
<kwd lng="en"><![CDATA[Clostridioides difficile]]></kwd>
<kwd lng="en"><![CDATA[Glutamate dehydrogenase]]></kwd>
<kwd lng="en"><![CDATA[Toxin A]]></kwd>
<kwd lng="en"><![CDATA[Toxin B]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bagdasarian]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Rao]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Malani]]></surname>
<given-names><![CDATA[PN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and treatment of clostridium difficile in adults:a systematic review]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2015</year>
<volume>313</volume>
<page-range>398-408</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McDonald]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Gerding]]></surname>
<given-names><![CDATA[DN]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Bakken]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Carroll]]></surname>
<given-names><![CDATA[KC]]></given-names>
</name>
<name>
<surname><![CDATA[Coffin]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical practice guidelines for clostridium difficile infection in adults and children:2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2018</year>
<volume>66</volume>
<page-range>e48</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shin]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
<name>
<surname><![CDATA[Moon]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[SY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of the VIDAS glutamate dehydrogenase assay for the detection of clostridium difficile]]></article-title>
<source><![CDATA[Anaerobe]]></source>
<year>2016</year>
<volume>40</volume>
<page-range>68-72</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Planche]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Karunaharan]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clostridium difficile]]></article-title>
<source><![CDATA[Medicine]]></source>
<year>2017</year>
<volume>45</volume>
<page-range>634-8</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goldenberg]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Cliff]]></surname>
<given-names><![CDATA[PR]]></given-names>
</name>
<name>
<surname><![CDATA[French]]></surname>
<given-names><![CDATA[GL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Glutamate dehydrogenase for laboratory diagnosis of Clostridium difficile infection]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2010</year>
<volume>48</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>3050-1</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
