Artificial Differences in <i>Clostridium difficile</i> Infection Rates Associated with Disparity in Testing

Kamboj, Mini; Brite, Jennifer; Aslam, Anoshé; Kennington, Jessica; Babady, N. Esther; Calfee, David P.; Furuya, Yoko; Chen, Donald; Augenbraun, Michael; Ostrowsky, Belinda; Patel, Gopi; Mircescu, Monica; Kak, Vivek; Tůma, Roman; Karre, Teresa A.; Fry, Deborah; Duhaney, Yola P.; Moyer, Amber M.; Mitchell, Denise; Cantu, Sherry; Hsieh, Candace; Warren, Nancy G.; Martin, Sean P.; Willson, Jill; Dickman, Jeanne; Knight, Julie; Delahanty, Kim M.; Flood, Annemarie; Harrington, Jennifer; Korenstein, Deborah; Eagan, Janet; Sepkowitz, Kent A.

doi:10.3201/eid2403.170961

Cited by 22 publications

(12 citation statements)

References 13 publications

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“…MLST multilocus sequence typing, CGE capillary gel electrophoresis, CQR Chongqing Ribotype New-ribo-type found in Chongqing, ST sequence type, RT ribotype Table 3 The and meta-analysis reported an incidence of 0.32 cases of CDI per 1000 patient admissions in Asia [5] and a similar result was verified in a 7-year retrospective study in a large university hospital in Eastern China [26]. This study reported a relatively low incidence of 0.18 per 1000 patient admissions, probably due to inadequate awareness of CDI among clinicians, low sensitivity of stool anaerobic culture for C. difficile detection, and low testing frequency [27]. Another possible reason is the missing information of a proportion of inpatients who might develop CDI after discharge.…”

Section: Discussionmentioning

confidence: 57%

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Dai

TianXiang²,

Yan

et al. 2020

BMC Infect Dis

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Background: Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China.Methods: A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing.Results: Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT-isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDTbeing more resistant than A + B + CDT-.Conclusions: Different genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.

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Section: Discussionmentioning

confidence: 57%

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Dai

TianXiang²,

Yan

et al. 2020

BMC Infect Dis

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“…Symptoms of primary and recurrent CDI can be particularly debilitating in persons with advanced age and are frequently associated with postinfectious irritable bowel syndrome ( 5 ). In patients receiving concomitant cancer therapy, CDI symptoms are often indistinguishable from the gastrointestinal side effects of chemotherapy, radiation, and newer immunotherapies ( 17 ). For these complex reasons, CDI during cancer treatment can lead to delays in future chemotherapy or radiation cycles and have been shown to negatively affect eligibility for curative treatment options ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Risk for Clostridiodes difficile Infection among Older Adults with Cancer

Kamboj¹,

Gennarelli²,

Brite³

et al. 2019

Emerg. Infect. Dis.

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“…The C . difficile tgNAAT CT could provide more information than the binary positive/negative result, by lower CTs predicting poorer outcomes [7, 8]. However, limitations of previous studies (single centre design, lack of optimal reference method, cohort sizes and use of composite outcome) mean that the relationship between CT value and CDI severity, including mortality, and risk of recurrence merits further investigation.…”

Section: Introductionmentioning

confidence: 99%

The predictive value of quantitative nucleic acid amplification detection of Clostridium difficile toxin gene for faecal sample toxin status and patient outcome

2018

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BackgroundLaboratory diagnosis of Clostridium difficile infection (CDI) remains unsettled, despite updated guidelines. We investigated the potential utility of quantitative data from a nucleic acid amplification test (NAAT) for C. difficile toxin gene (tg) for patient management.MethodsUsing data from the largest ever C. difficile diagnostic study (8853 diarrhoeal samples from 7335 patients), we determined the predicative value of C. difficile tgNAAT (Cepheid Xpert C.diff) low cycle threshold (CT) value for patient toxin positive status, CDI severity, mortality and CDI recurrence. Reference methods for CDI diagnosis were cytotoxicity assay (CTA) and cytotoxigenic culture (CTC).ResultsOf 1281 tgNAAT positive faecal samples, 713 and 917 were CTA and CTC positive, respectively. The median tgNAAT CT for patients who died was 25.5 vs 27.5 for survivors (p = 0.021); for toxin-positivity was 24.9 vs 31.6 for toxin-negative samples (p<0.001) and for patients with a recurrence episode was 25.6 vs 27.3 for those who did not have a recurrent episode (p = 0.111). Following optimal cut-off determination, low CT was defined as ≤25 and was significantly associated with a toxin-positive result (P<0.001, positive predictive value 83.9%), presence of PCR-ribotype 027 (P = 0.025), and mortality (P = 0.032). Recurrence was not associated with low CT (p 0.111).ConclusionsLow tgNAAT CT could indicate CTA positive patients, have more severe infection, increased risk of mortality and possibly recurrence. Although, the limited specificity of tgNAAT means it cannot be used as a standalone test, it could augment a more timely diagnosis, and optimise management of these at-risk patients.

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Artificial Differences in Clostridium difficile Infection Rates Associated with Disparity in Testing

Cited by 22 publications

References 13 publications

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Risk for Clostridiodes difficile Infection among Older Adults with Cancer

The predictive value of quantitative nucleic acid amplification detection of Clostridium difficile toxin gene for faecal sample toxin status and patient outcome

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