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Use of a Perianal Swab Compared With a Stool Sample to Detect Symptomatic Clostridium difficile Infection

Published online by Cambridge University Press:  05 April 2017

Marisa A. Montecalvo ,
Emnet Sisay ,
Donna McKenna ,
Guiqing Wang ,
Paul Visintainer  and
Gary P. Wormser
Marisa A. Montecalvo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Emnet Sisay
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Donna McKenna
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Guiqing Wang
Affiliation:
Department of Pathology, New York Medical College, Valhalla, New York
Paul Visintainer
Affiliation:
Office of Research, Baystate Medical Center, Springfield, Massachusetts
Gary P. Wormser
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
*
Address correspondence to Marisa A. Montecalvo, MD, Division of Infectious Diseases, New York Medical College, 40 Sunshine Cottage Road, Valhalla, New York 10595 (marisa_montecalvo@nymc.edu).
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Abstract

OBJECTIVE

To evaluate the use of a perianal swab to detect CDI.

METHODS

A perianal swab was collected from each inpatient with a positive stool sample for C. difficile (by polymerase chain reaction [PCR] test) and was tested for C. difficile by PCR and by culture. The variables evaluated included demographics, CDI severity, bathing before perianal swab collection, hours between stool sample and perianal swab, cycle threshold (Ct) to PCR positivity, and doses of CDI treatment before stool sample and before perianal swab.

RESULTS

Of 83 perianal swabs, 59 (71.1%) tested positive for C. difficile by PCR when perianal swabs were collected an average of 21 hours after the stool sample. Compared with the respective stool sample, the perianal sample was less likely to grow C. difficile (P=.005) and had a higher PCR Ct (P<.001). A direct, significant but weak correlation was detected between the Ct for a positive perianal sample and the respective stool sample (r=0.36; P=.006). An inverse dose relationship was detected between PCR positivity and CDI treatment doses before perianal swab collection (P=.27).

CONCLUSION

Perianal swabs are a simple method to detect C. difficile tcdB gene by PCR, with a sensitivity of 71%. These data were limited because stool samples and perianal swabs were not collected simultaneously. Compared with stool samples, the perianal Ct values and culture results were consistent with a lower bacterial load on the perianal sample due to the receipt of more CDI treatment before collection or unknown factors affecting perianal skin colonization.

Infect Control Hosp Epidemiol 2017;38:658–662

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 658 - 662
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
2. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle Scholar
3. Montecalvo, MA, Jarvis, WR, Uman, J, et al. Infection control measures reduce transmission of vancomycin resistant enterococci in an endemic setting. Ann Intern Med 1999;131:269–272.CrossRefGoogle Scholar
4. Luna, RA, Boyanton, BL Jr, Mehta, S, et al. Rapid stool-based diagnosis of Clostridium difficile infection by real-time PCR in a children’s hospital. J Clin Microbiol 2011;49:851–857.Google Scholar
5. Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Published 2014. Accessed February 24, 2017.Google Scholar
6. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478–498.Google Scholar
7. Sunkesula, VC, Kundrapu, S, Muganda, C, Sethi, AK, Donskey, CJ. Does empirical Clostridium difficile infection (CDI) therapy result in false-negative CDI diagnostic test results? Clin Infect Dis 2013;57:494–500.Google Scholar
8. Shakir, FA, Thompson, D, Marlar, R, Ali, T. A novel use of rectal swab test for Clostridium difficile infection by real-time PCR. Am J Gastroenterol 2012;107:1444–1445.CrossRefGoogle ScholarPubMed
9. Kundrapu, S, Sunkesula, VCK, Jury, LA, Sethi, AK, Donskey, CJ. Utility of perirectal swab specimens for diagnosis of Clostridium difficile infection. Clin Infect Dis 2012;55:1527–1530.Google Scholar
10. Rogers, DS, Kundrapu, S, Sunkesula, VCK, Donskey, CJ. Comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic. Clostridium difficile. J Clin Microbiol 2013;51:3421–3422.CrossRefGoogle ScholarPubMed
11. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
12. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561–567.Google Scholar
13. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and non-epidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.Google Scholar
14. Longtin, Y, Paquet-Boulduc, B, Gilca, R, et al. Effect of detecting and isolating Clostiridium difficile carriers at hospital admission on the incidence of C. difficile infections: a quasi-experimental controlled study. JAMA. Intern Med 2016;176:796–804.Google Scholar
15. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:1195–1205.CrossRefGoogle ScholarPubMed
16. Curry, SR, Muto, CA, Schlackman, JL, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in C. difficile transmission. Clin Infect. Dis 2013;57:1094–1102.Google Scholar