诊断检测结果不一致和治疗实践：瑞士日内瓦一家三级保健医院的横断面研究。
Discordant diagnostic assay and treatment practice: a cross-sectional study in a tertiary care hospital, Geneva, Switzerland.
机构信息
Division of Infectious Diseases, Geneva University Hospitals, Geneve, Switzerland.
University of Geneva Medical School, Geneve, Switzerland.
出版信息
BMJ Open. 2020 Sep 13;10(9):e036342. doi: 10.1136/bmjopen-2019-036342.
OBJECTIVES
To determine the proportion of patients who received a treatment for infection (CDI) among those presenting a discordant diagnostic assay and to identify patient characteristics associated with the decision to treat CDI.
DESIGN
Cross-sectional study.
SETTING
Monocentric study in a tertiary care hospital, Geneva, Switzerland.
PARTICIPANTS
Among 4562 adult patients tested for between March 2017 and March 2019, 208 patients with discordant tests' results (positive nucleic acid amplification test (NAAT+)/negative enzyme immunoassay (EIA-)) were included.
MAIN OUTCOME MEASURES
Treatment for CDI.
RESULTS
CDI treatment was administered in 147 (71%) cases. In multivariate analysis, an abdominal CT scan with signs of colitis (OR 14.7; 95% CI 1.96 to 110.8) was the only factor associated with CDI treatment.
CONCLUSIONS
The proportion of NAAT+/EIA- patients who received treatment questions the contribution of the EIA for the detection of toxin A/B after NAAT to limit overtreatment. Additional studies are needed to investigate if other factors are associated with the decision to treat.
目的
确定在诊断检测结果不一致的患者中，接受感染（CDI）治疗的患者比例，并确定与 CDI 治疗决策相关的患者特征。
设计
横断面研究。
地点
瑞士日内瓦一家三级保健医院的单中心研究。
参与者
在 2017 年 3 月至 2019 年 3 月期间接受检测的 4562 名成年患者中，纳入 208 名检测结果不一致（核酸扩增试验（NAAT+）阳性/酶免疫测定（EIA-）阴性）的患者。
主要观察指标
CDI 治疗。
结果
在 147 例（71%）中进行了 CDI 治疗。多变量分析显示，具有结肠炎征象的腹部 CT 扫描（OR 14.7；95%CI 1.96 至 110.8）是与 CDI 治疗唯一相关的因素。
结论
接受治疗的 NAAT+/EIA-患者比例质疑在 NAAT 后通过 EIA 检测毒素 A/B 以限制过度治疗的作用。需要进一步研究以调查是否存在其他与治疗决策相关的因素。
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