Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
Sopena, Nieves (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Wang-Wang, Jun Hao (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Casas, Irma (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Mateu, Lourdes (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Castellà, Laia (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
García-Quesada, María José (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Gutiérrez-Enríquez, Sara (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Llibre, Josep M.. (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pedro-Botet, M. Luisa (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Fernandez Rivas, Gema (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Our aim was to determine changes in the incidence of CD infection (CDI) following the introduction of a two-step diagnostic algorithm and to analyze CDI cases diagnosed in the study period. We retrospectively studied CDI (January 2009 to July 2018) in adults diagnosed by toxin enzyme immunoassay (EIA) (2009-2012) or toxin-EIA + polymerase chain reaction (PCR) algorithm (2013 onwards). A total of 443 patients with a first episode of CDI were included, 297 (67. 1%) toxin-EIA-positive and 146 (32. 9%) toxin-EIA-negative/PCR-positive were only identified through the two-step algorithm including the PCR test. The incidence of CDI increased from 0. 9 to 4. 7/10,000 patient-days (p < 0. 01) and 146 (32. 9%) toxin-negative CDI were diagnosed. Testing rate increased from 24. 4 to 59. 5/10,000 patient-days (p < 0. 01) and the percentage of positive stools rose from 3. 9% to 12. 5% (p < 0. 01). CD toxin-positive patients had a higher frequency of severe presentation and a lower rate of immunosuppressive drugs and inflammatory bowel disease. Mortality (16. 3%) was significantly higher in patients with hematological neoplasm, intensive care unit admission and complicated disease. Recurrences (14. 9%) were significantly higher with proton pump inhibitor exposure. The two-step diagnostic algorithm facilitates earlier diagnosis, potentially impacting patient outcomes and nosocomial spread. CD-toxin-positive patients had a more severe clinical presentation, probably due to increased CD bacterial load with higher toxin concentration. This early and easy marker should alert clinicians of potentially more severe outcomes.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Clostridioides difficile ; Clostridioides difficile toxin ; Healthcare-associated infection ; Infection control and prevention ; Immunosuppressed patients
Published in:	Microorganisms, Vol. 10 (may 2022) , ISSN 2076-2607

DOI: 10.3390/microorganisms10051075
PMID: 35630517

12 p, 658.2 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles