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Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test.
Guh, Alice Y; Fridkin, Scott; Goodenough, Dana; Winston, Lisa G; Johnston, Helen; Basiliere, Elizabeth; Olson, Danyel; Wilson, Christopher D; Watkins, Jasmine J; Korhonen, Lauren; Gerding, Dale N.
Afiliação
  • Guh AY; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Fridkin S; Emory University School of Medicine, Atlanta, Georgia.
  • Goodenough D; Georgia Emerging Infections Program, Decatur, Georgia.
  • Winston LG; Emory University School of Medicine, Atlanta, Georgia.
  • Johnston H; Georgia Emerging Infections Program, Decatur, Georgia.
  • Basiliere E; Atlanta Veterans' Affairs Medical Center, Decatur, Georgia.
  • Olson D; University of California, San Francisco, School of Medicine, San Francisco, California.
  • Wilson CD; Colorado Department of Public Health and Environment, Denver, Colorado.
  • Watkins JJ; Colorado Department of Public Health and Environment, Denver, Colorado.
  • Korhonen L; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut.
  • Gerding DN; Tennessee Department of Health, Nashville, Tennessee.
Infect Control Hosp Epidemiol ; 45(5): 590-598, 2024 May.
Article em En | MEDLINE | ID: mdl-38268440
ABSTRACT

OBJECTIVE:

Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (-). We compared NAAT+/toxin- and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin- patients.

DESIGN:

Retrospective observational study.

SETTING:

The study was conducted across 36 laboratories at 5 Emerging Infections Program sites. PATIENTS We defined a CDI case as a positive test detected by this 2-step algorithm during 2018-2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks.

METHODS:

We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin- and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin- cases.

RESULTS:

Of 1,801 cases, 1,252 were NAAT+/toxin-, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin- cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin- status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55-0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87-1.28). Among NAAT+/toxin- cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28-2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40-2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23-4.68) were predictors of CDI treatment.

CONCLUSION:

Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin- cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin- cases.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Toxinas Bacterianas / Clostridioides difficile / Infecções por Clostridium Tipo de estudo: Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Toxinas Bacterianas / Clostridioides difficile / Infecções por Clostridium Tipo de estudo: Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article