Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundanggu, Seongnam, 13620, Korea.
Division of Infectious Diseases, Department of Internal Medicine, Incheon Sejong Hospital, Incheon, Korea.
Antimicrob Resist Infect Control. 2022 May 13;11(1):70. doi: 10.1186/s13756-022-01111-0.
Given the increasing incidence of Clostridioides difficile infections in Korea, there has been an increase in inappropriate testing for C. difficile, which has rendered overdiagnosis of asymptomatic colonisers common. We aimed to investigate the appropriateness of C. difficile testing and the related factors.
We retrospectively reviewed the medical records of patients who were admitted to a 1300-bed tertiary-care teaching hospital in Korea and were tested for C. difficile infection from September 2019 to November 2019. We performed logistic regression analysis to investigate factors related to inappropriate testing. Further, a survey was conducted on physicians to assess the knowledge and ordering patterns of C. difficile testing.
We included 715 tests from 520 patients in the analysis. Testing was classified as hospital-onset and community-onset and subclassified as appropriate and inappropriate following an algorithmic method. Among the 715 tests, 576 (80.6%) and 139 (19.6%) tests were classified as hospital-onset and community-onset, respectively. Among the hospital-onset tests, 297 (52%) were considered inappropriate. The risk of inappropriate testing increased when C. difficile tests were conducted in the emergency room (OR 24.96; 95% CI 3.12-199.98) but decreased in intensive care units (OR 0.36, 95% CI 0.19-0.67). The survey was conducted on 61 physicians. Internal medicine physicians had significantly higher scores than non-internal medicine physicians (7.1 vs. 5.7, p = 0.001). The most frequently ordered combination of tests was toxin + glutamate dehydrogenase (47.5%), which was consistent with the ordered tests.
Almost half of the C. difficile tests were performed inappropriately. The patient being located in the emergency room and intensive care unit increased and decreased the risk of inappropriate testing, respectively. In a questionnaire survey, we showed that internal medicine physicians were more knowledgeable about C. difficile testing than non-internal medicine physicians. There is a need to implement the diagnostic stewardship for C. difficile, especially through educational interventions for emergency room and non-internal medicine physicians.
鉴于韩国艰难梭菌感染的发病率不断上升，对艰难梭菌的检测呈不恰当增加趋势，导致无症状定植者的过度诊断变得普遍。本研究旨在调查艰难梭菌检测的适宜性及其相关因素。
我们回顾性分析了 2019 年 9 月至 2019 年 11 月期间在韩国一家 1300 床位的三级教学医院住院并接受艰难梭菌感染检测的患者的病历。我们进行了逻辑回归分析，以调查与不适当检测相关的因素。此外，我们还对医生进行了一项关于艰难梭菌检测的知识和检测模式的调查。
我们将分析纳入了 520 名患者的 715 次检测。根据算法方法，检测被分为医院发病和社区发病，并进一步细分为适当和不适当。在 715 次检测中，分别有 576（80.6%）和 139（19.6%）次检测被归类为医院发病和社区发病。在医院发病检测中，有 297 次（52%）被认为是不适当的。当艰难梭菌检测在急诊室进行时，不适当检测的风险增加（OR 24.96；95%CI 3.12-199.98），而在重症监护病房则降低（OR 0.36，95%CI 0.19-0.67）。我们对 61 名医生进行了调查。内科医生的得分明显高于非内科医生（7.1 分比 5.7 分，p=0.001）。最常组合检测的是毒素+谷氨酸脱氢酶（47.5%），这与实际检测结果一致。
近一半的艰难梭菌检测是不适当的。患者在急诊室和重症监护病房的位置分别增加和降低了不适当检测的风险。在问卷调查中，我们发现内科医生比非内科医生对艰难梭菌检测的了解更多。需要实施艰难梭菌的诊断管理，特别是通过对急诊室和非内科医生进行教育干预。
