Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infection Prevention, Indiana University Health, Indianapolis, IN, USA.
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Clin Microbiol Infect. 2023 Jun;29(6):798.e1-798.e4. doi: 10.1016/j.cmi.2023.02.008. Epub 2023 Feb 19.
Diagnosis of Clostridium difficile infection (CDI) can be challenging due to high colonization rates. Unlike PCR-only testing, two-step algorithm testing (that includes toxin and PCR) may help differentiate colonization from active infection, but it is unknown if this type of testing impacts treatment decisions. We examined the association between changing CDI diagnostic methods, the way the testing results were displayed, and the rates of CDI-specific treatment.
We performed a retrospective analysis of positive C. difficile cases over 2 years, a year preceding and following our institution's transition from PCR to two-step testing. During the PCR period, results were displayed in the electronic medical record as 'positive'. In the two-step period, positive results were either displayed as 'likely colonized' or 'toxin positive'. Rates of CDI-specific therapy and adverse patient outcomes (30-day mortality and intensive care unit admission) were compared among the three groups.
A total of 610 patients had positive results over the study period. Of the 354 patients in the PCR group, 329 (93%) were treated with CDI-specific therapy. Of the 142 patients in the likely colonized group, 59 (42%) were treated. All 114 patients in the toxin-positive group were treated. Multivariate analysis of patients who were PCR positive or likely colonized showed that tests sent in the two-step era were less likely to be associated with treatment for CDI (odds ratio 0.05, 95% CI 0.03-0.09).
We found a correlation between changing the type of test and the way the results were displayed and reduction in CDI-specific antibiotic use without restricting clinician diagnostic ordering.
由于高定植率，艰难梭菌感染（CDI）的诊断具有挑战性。与仅 PCR 检测不同，两步法检测（包括毒素和 PCR）可能有助于区分定植和活动性感染，但尚不清楚这种检测方法是否会影响治疗决策。我们研究了改变 CDI 诊断方法、检测结果显示方式以及 CDI 特异性治疗率之间的关系。
我们对 2 年来阳性艰难梭菌病例进行了回顾性分析，在我们机构从 PCR 转为两步法检测的前一年和后一年。在 PCR 期间，检测结果在电子病历中显示为“阳性”。在两步法期间，阳性结果显示为“可能定植”或“毒素阳性”。比较了三组患者的 CDI 特异性治疗率和不良患者结局（30 天死亡率和重症监护病房入住率）。
在研究期间，共有 610 名患者的检测结果为阳性。在 PCR 组的 354 名患者中，有 329 名（93%）接受了 CDI 特异性治疗。在可能定植组的 142 名患者中，有 59 名（42%）接受了治疗。所有 114 名毒素阳性患者均接受了治疗。对 PCR 阳性或可能定植的患者进行多变量分析表明，两步法检测的检测结果与 CDI 治疗的相关性较低（比值比 0.05，95%CI 0.03-0.09）。
我们发现改变检测类型和显示结果的方式与减少 CDI 特异性抗生素使用之间存在相关性，而不会限制临床医生的诊断医嘱。
