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Real-world evaluation of a two-step testing algorithm for Clostridioides difficile infection

Published online by Cambridge University Press:  08 February 2023

Michelle T. Hecker ,
Andrea H. Son ,
Patricia Zuccaro ,
Jennifer Conti  and
Curtis J. Donskey
Michelle T. Hecker*
Affiliation:
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Andrea H. Son
Affiliation:
Department of Pharmacy, MetroHealth Medical Center, Cleveland, Ohio
Patricia Zuccaro
Affiliation:
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
Jennifer Conti
Affiliation:
Department of Population Health, MetroHealth Medical Center, Cleveland, Ohio
Curtis J. Donskey
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
*
Author for correspondence: Michelle T. Hecker, E-mail: mhecker@metrohealth.org
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Abstract

During the 4 years after implementation of the 2-step Clostridioides difficile infection (CDI) testing algorithm, 70% to 78% of patients with suspected CDI and a positive nucleic acid amplification test but a negative toxin test (NAAT+/TOX−) received CDI treatment. Overall, 73% of NAAT+/TOX− patients were classified as having probable or possible CDI.

Type
Concise Communication
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 9 , September 2023 , pp. 1494 - 1496
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Creative Commons
To the extent this is a work of the US Government, it is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Department of Veterans Affairs and the Author(s), 2023

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References

Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 2015;175:1792–1801.CrossRefGoogle ScholarPubMed
Donskey, CJ, Kundrapu, S, Deshpande, A. Colonization versus carriage of Clostridium difficile . Infect Dis Clin North Am 2015;29:13–28.10.1016/j.idc.2014.11.001CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. 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). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Guh, AY, Hatfield, KM, Winston, LG, et al. Toxin enzyme immunoassays detect Clostridioides difficile infection with greater severity and higher recurrence rates. Clin Infect Dis 2019;69:1667–1674.CrossRefGoogle ScholarPubMed
Miller, R, Morillas, JA, Brizendine, KD, Fraser, TG. Predictors of Clostridioides difficile infection-related complications and treatment patterns among nucleic acid amplification test-positive/toxin enzyme immunoassay-negative patients. J Clin Microbiol 2020;58:e01764–19.10.1128/JCM.01764-19CrossRefGoogle ScholarPubMed
Guerrero, DM, Chou, C, Jury, LA, Nerandzic, MM, Cadnum, JC, Donskey, CJ. Clinical and infection control implications of Clostridium difficile infection with negative enzyme immunoassay for toxin. Clin Infect Dis 2011;53:287–290.CrossRefGoogle ScholarPubMed
Dolan, M, Cox, H, Warren, CA, et al. Abstract 754. A two-step testing algorithm for hospital-onset Clostridioides difficile infection (CDI) reduces prescribing of C. difficile (CD) therapy but its ability to guide treatment decisions remains unclear. Open Forum Infect Dis 2021;8 suppl 1:474.10.1093/ofid/ofab466.951CrossRefGoogle Scholar
Hogan, CA, Hitchcock, MM, Frost, S, Kapphahn, K, Holubar, M, Tompkins, LS, Banaei, N. Clinical outcomes of treated and untreated C. difficile PCR-positive/toxin-negative adult hospitalized patients: a quasi-experimental noninferiority study. J Clin Microbiol 2022;60:e0218721.10.1128/jcm.02187-21CrossRefGoogle ScholarPubMed
Bignardi, GE, Hill, K, Berrington, A, Settle, CD. Two-stage algorithm for Clostridium difficile: glutamate-dehydrogenase-positive toxin-negative enzyme immunoassay results may require further testing. J Hosp Infect 2013;83:347–349.CrossRefGoogle ScholarPubMed
Alonso, CD, Kelly, CP, Garey, KW, et al. Ultrasensitive and quantitative toxin measurement correlates with baseline severity, severe outcomes, and recurrence among hospitalized patients with Clostridioides difficile infection. Clin Infect Dis 2022;74:2142–2149.CrossRefGoogle ScholarPubMed
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