Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
Infect Control Hosp Epidemiol. 2021 Oct;42(10):1228-1234. doi: 10.1017/ice.2020.1405. Epub 2021 Feb 24.
Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI.
Retrospective cohort study.
Single tertiary-care hospital.
Adult patients diagnosed with hospital-onset, healthcare facility-associated CDI from June 2014 to September 2015.
We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality.
Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe-complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23-40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72-0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90-1.09) or recurrence (OR, 0.88; 95% CI, 0.77-1.00).
Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.
艰难梭菌感染（CDI）会导致较高的发病率和死亡率；然而，CDI 的诊断仍存在争议。我们研究的主要目的是评估聚合酶链反应（PCR）循环阈值（Ct）值与成年 CDI 患者的 CDI 严重程度、复发和死亡率之间的相关性。
回顾性队列研究。
单家三级保健医院。
2014 年 6 月至 2015 年 9 月期间诊断为医院获得性、医疗机构相关 CDI 的成年患者。
我们对纳入的患者进行了回顾性病历审查。采用单变量和多变量逻辑回归方法评估 Ct 值与 CDI 严重程度、8 周复发和 30 天死亡率之间的关系。
在 318 例纳入患者中，51%为男性，平均年龄为 62 岁；约 32%的患者发生严重 CDI，11%发生严重并发症 CDI。30 天全因死亡率为 11%，8 周复发率为 9.5%。总体平均 Ct 值为 32.9（范围，23-40）。多变量分析显示，PCR Ct 值越低，30 天死亡率的比值比（OR）越高（OR，0.83；95%置信区间[CI]，0.72-0.96），但与 CDI 严重程度（OR，0.99；95% CI，0.90-1.09）或复发（OR，0.88；95% CI，0.77-1.00）无关。
我们的研究结果表明，在诊断时的 PCR Ct 值可能对 CDI 住院患者的临床决策具有有限的预测价值和实用性。需要在不同患者人群中开展更大规模的前瞻性研究来证实我们的研究结果。
