Bilinskaya Anastasia, Goodlet Kellie J, Nailor Michael D
University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT 06269, USA.
Midwestern University College of Pharmacy - Glendale, 19555 N 59th Ave, Glendale, AZ 85308, USA.
Diagn Microbiol Infect Dis. 2018 Sep;92(1):50-55. doi: 10.1016/j.diagmicrobio.2018.04.009. Epub 2018 Apr 21.
This study examined the effect of an alert notifying providers ordering Clostridium difficile PCR when their patient received a laxative within 24 hours at four hospitals.
All patients whose provider received the laxative alert when ordering C. difficile testing were examined.
Three hundred sixty-six patients had 483 alerts triggered, with 75% overridden. While 74% of patients had ≥2 bowel movements immediately pre-order, 33% of C. difficile tests were not performed due to no stool production post-order or laboratory rejection of formed stool. Of those with completed tests, 49% had ≤1 cardinal sign of C. difficile infection (CDI) and only 18% tested positive by PCR. There were no differences in frequency of CDI signs between the PCR-positive and PCR-negative patients.
C. difficile testing was common among patients receiving laxatives. Patients testing positive for C. difficile looked clinically similar to patients testing negative, suggesting a high false-positive rate.
本研究在四家医院调查了一种警示措施的效果，该警示用于通知在患者24小时内接受过泻药治疗时开具艰难梭菌聚合酶链反应（PCR）检测医嘱的医护人员。
对所有在开具艰难梭菌检测医嘱时其医护人员收到泻药警示的患者进行检查。
366例患者触发了483次警示，其中75%被忽略。虽然74%的患者在开具医嘱前立即有≥2次排便，但33%的艰难梭菌检测未进行，原因是开具医嘱后无粪便排出或实验室拒收成形粪便。在完成检测的患者中，49%有≤1项艰难梭菌感染（CDI）主要体征，且仅18%通过PCR检测呈阳性。PCR阳性和PCR阴性患者的CDI体征出现频率无差异。
在接受泻药治疗的患者中，艰难梭菌检测很常见。艰难梭菌检测呈阳性的患者在临床上与检测呈阴性的患者相似，提示假阳性率很高。
