两医院经验：不报告多重胃肠 PCR 检测板艰难梭菌结果对艰难梭菌感染漏诊率及后果的影响。
Rate and consequences of missed Clostridioides (Clostridium) difficile infection diagnosis from nonreporting of Clostridioides difficile results of the multiplex GI PCR panel: experience from two-hospitals.
机构信息
Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA.
Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA.
出版信息
Diagn Microbiol Infect Dis. 2021 Jun;100(2):115346. doi: 10.1016/j.diagmicrobio.2021.115346. Epub 2021 Feb 12.
INTRODUCTION
It is common among microbiology laboratories to blind the Clostridioides difficile (C. difficile) BioFire FilmArray GI Panel result in fear of overdiagnosis.
METHODS
We examined the rate of missed community-onset C. difficile infection (CDI) diagnosis and associated outcomes. Adult patients with FilmArray GI Panel positive for C. difficile on hospital admission who lacked dedicated C. difficile testing were included.
RESULTS
Among 144 adults with a FilmArray Panel positive for C. difficile, 18 did not have concurrent dedicated C. difficile testing. Eight patients were categorized as possible, 5 as probable and 4 as definite cases of missed CDI diagnosis. We observed associated delays in initiation of appropriate therapy, intensive care unit admissions, hospital readmissions, colorectal surgery and death/discharge to hospice. Five out of 17 lacked risk factors for CDI.
CONCLUSION
The practice of concealing C. difficile FilmArray GI Panel results needs to be reconsidered in patients presenting with community-onset colitis.
引言
微生物学实验室普遍存在对艰难梭菌（C. difficile）生物火膜阵列 GI 面板结果进行盲目检测的情况，担心过度诊断。
方法
我们研究了漏诊社区获得性艰难梭菌感染（CDI）的发生率和相关结局。纳入在入院时 FilmArray GI 面板检测出艰难梭菌阳性，但没有进行专门的艰难梭菌检测的成年患者。
结果
在 144 名艰难梭菌 FilmArray 面板阳性的成年人中，有 18 名患者没有同时进行专门的艰难梭菌检测。8 例患者被归类为可能病例，5 例为疑似病例，4 例为确诊的漏诊 CDI 病例。我们观察到与适当治疗的开始、重症监护病房入院、医院再入院、结肠直肠手术和死亡/转往临终关怀相关的延迟。17 例中，有 5 例没有 CDI 的危险因素。
结论
对于以社区获得性结肠炎就诊的患者，需要重新考虑对艰难梭菌 FilmArray GI 面板结果进行隐瞒的做法。
Zotero 插件