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Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

Published online by Cambridge University Press:  18 September 2018

Erik R. Dubberke ,
Kimberly A. Reske ,
Tiffany Hink ,
Jennie H. Kwon ,
Candice Cass ,
Jahnavi Bongu ,
Carey-Ann D. Burnham  and
Jeffrey P. Henderson
Erik R. Dubberke*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Jennie H. Kwon
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Candice Cass
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Jahnavi Bongu
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Department of Pathology and Immunology, Department of Molecular Microbiology, and Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Jeffrey P. Henderson
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Author for correspondence: Erik Dubberke MD, MSPH, Washington University School of Medicine, 4523 Clayton Ave, Box 8051, St Louis, MO 63110. E-mail: edubberk@wustl.edu
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Abstract

Objective

To determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.

Design

Retrospective cohort.

Setting

Tertiary-care hospital in St. Louis, Missouri.

Patients

Patients whose diarrheal stool samples were submitted to the hospital’s clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.

Interventions

Electronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.

Results

A total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (−). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA− stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA− stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).

Conclusions

Most patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA− patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1330 - 1333
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

1. Burnham, CA, Carroll, KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2013;26:604–630.Google Scholar
2. 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.Google Scholar
3. Dubberke, ER, Burnham, CD. Diagnosis of Clostridium difficile infection: treat the patient, not the test. JAMA Intern Med 2015;175:1801–1802.Google Scholar
4. Quan, KA, Yim, J, Merrill, D, et al. Reductions in Clostridium difficile infection (CDI) rates using real-time automated clinical criteria verification to enforce appropriate testing. Infect Control Hosp Epidemiol 2018;39:625–627.Google Scholar
5. Madden, GR, German Mesner, I, Cox, HL, et al. Reduced Clostridium difficile tests and laboratory-identified events with a computerized clinical decision support tool and financial incentive. Infect Control Hosp Epidemiol 2018;39:737–740.Google Scholar
6. Casari, E, De Luca, C, Calabro, M, Scuderi, C, Daleno, C, Ferrario, A. Reducing rates of Clostridium difficile infection by switching to a stand-alone NAAT with clear sampling criteria. Antimicrob Resist Infect Control 2018;7:40.Google Scholar
7. 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;66:987–994.Google Scholar
8. 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.Google Scholar
9. Dubberke, ER, Han, Z, Bobo, L, et al. Impact of clinical symptoms on interpretation of diagnostic assays for Clostridium difficile infections. J Clin Microbiol 2011;49:2887–2893.Google Scholar
10. Kaltsas, A, Simon, M, Unruh, LH, et al. Clinical and laboratory characteristics of Clostridium difficile infection in patients with discordant diagnostic test results. J Clin Microbiol 2012;50:1303–1307.Google Scholar
11. Longtin, Y, Trottier, S, Brochu, G, et al. Impact of the type of diagnostic assay on Clostridium difficile infection and complication rates in a mandatory reporting program. Clin Infect Dis 2013;56:67–73.Google Scholar
12. Planche, TD, Davies, KA, Coen, PG, et al. Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C. difficile infection. Lancet Infect Dis 2013;13:936–945.Google Scholar
13. Hink, T, Burnham, CA, Dubberke, ER. A systematic evaluation of methods to optimize culture-based recovery of Clostridium difficile from stool specimens. Anaerobe 2013;19:39–43.Google Scholar
14. Alasmari, F, Seiler, SM, Hink, T, Burnham, CA, Dubberke, ER. Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis 2014;59:216–222.Google Scholar
15. Dubberke, ER, Reske, KA, Seiler, S, Hink, T, Kwon, JH, Burnham, CA. Risk factors for acquisition and loss of Clostridium difficile colonization in hospitalized patients. Antimicrob Agents Chemother 2015;59:4533–4543.Google Scholar
16. Westblade, LF, Chamberland, RR, MacCannell, D, et al. Development and evaluation of a novel, semiautomated Clostridium difficile typing platform. J Clin Microbiol 2013;51:621–624.Google Scholar
17. Crobach, MJT, Baktash, A, Duszenko, N, Kuijper, EJ. Diagnostic guidance for C. difficile infections. Adv Exper Med Biol 2018;1050:27–44.Google Scholar