Clostridium difficile Colitis: An Efficient Clinical Approach to Diagnosis

Manabe, Yukari C.; Vinetz, Joseph M.; Moore, Richard D.; Merz, C S; Charache, Patricia; Bartlett, John G.

doi:10.7326/0003-4819-123-11-199512010-00004

Cited by 168 publications

(85 citation statements)

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“…14,17,[21][22][23][24] Although our local experience revealed cephalosporin use to be predictive of cytotoxin results in both the validation and derivation sets, others have demonstrated associations for different classes of antibiotics, [25][26][27] and have shown reduced rates of C. diffi- cile-associated disease when the usage of these antibiotics was restricted. 28 Thus, to enhance the generalizability of our models to other hospital settings, we did not present models including specific antibiotic variables (e.g., prior cephalosporin use) in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…20 In a recent study, Manabe et al reported that cephalosporin use, the presence of semiformed stool, and the presence of fecal leukocytes were independently predictive of C. difficile toxin results. 14 Our study has the important advantage that it used clinical criteria alone to define a patient subgroup at very low risk of C. difficile-associated disease. Using clinical data alone is much more practical and economical than using one or more laboratory tests to decide whether or not to perform others.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent stool samples were not considered in our analysis, as the yield of positive assays was much lower for this group of specimens compared with first submitted specimens. 11,14 Demographic data included age and gender. Other descriptive data included primary admitting diagnosis, duration of hospitalization up to the date of testing, hospital service (e.g., medical vs surgical), and level of care (e.g., intensive care unit vs general care unit) at diarrhea onset.…”

Section: Data Collectionmentioning

confidence: 99%

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Predicting Clostridium difficile Stool Cytotoxin Results in Hospitalized Patients with Diarrhea

et al. 1997

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OBJECTIVE: To validate a model for the prediction of Clostridium difficile cytotoxin assay results, and to identify a subgroup of patients with a very low likelihood of C. difficile -associated disease in whom the yield of routine cytotoxin testing is low. DESIGN:Prospective cohort study. Relevant clinical symptoms, signs, and antibiotic exposure were recorded before reporting of assay results. Each predictor was assigned a score based on regression coefficients, and patients were stratified according to their total score. SETTING:Two urban, tertiary care, university hospitals. PATIENTS:A total of 609 consecutive adult inpatients who received testing for C. difficile cytotoxin during a 3-month period in 1994. MEASUREMENTS AND MAIN RESULTS:The prevalence of positive cytotoxin assays was 8% in the validation set, compared with 14% in the derivation set. Defining patients without both prior antibiotic use and at least one symptom predictor (significant diarrhea or abdominal pain) as a low-risk subgroup, the misclassification rate was 2.8% (5/177) for assay results; of the five misclassified cases patients, only one was judged to have C. difficile -associated disease. Use of this rule to identify low-risk patients could have potentially averted 29% of all cytotoxin assays. lostridium difficile accounts for substantial morbidity in hospitalized patients and has been recognized to be the most common cause of antibiotic-associated colitis. 1 Disease associated with C. difficile is also costly. In one study, C. difficile colitis during hospitalization accounted for $2,000 in additional charges per patient. 2 Testing for C. difficile accounted for nearly 68% of total hospital charges associated with the laboratory evaluation of diarrhea in another study. 3 The most widely used method for diagnosis of C. difficile -associated disease is based on detecting a cytotoxin produced by C. difficile by means of a tissue culture assay. 4,5 The yield of C. difficile toxin testing in hospitalized patients with diarrhea has been reported to be approximately 20% in patients hospitalized longer than 3 days. [6][7][8][9] Other investigators, however, have suggested that approximately 40% of testing for C. difficile could be eliminated by using selective criteria. 10 Moreover, the yield of serial (repeated) tests for C. difficile toxin has been reported to be low. 11 In a retrospective study of consecutive patients who underwent first-time testing for C. difficile cytotoxin at a university medical center, where the overall prevalence of positive cytotoxin assays was 14%, Katz et al. developed a simple three-variable decision rule. 5 This rule identified a clinical subgroup at low risk of positive cytotoxin assay results (patients without the combination of antibiotic use within 30 days prior to testing and either a significant diarrhea or abdominal pain). This subgroup accounted for 37% of all cytotoxin assays performed. CONCLUSIONS:Although the subjects of this earlier study had a broad range of symptoms and exposure histories, they wer...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

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Predicting Clostridium difficile Stool Cytotoxin Results in Hospitalized Patients with Diarrhea

et al. 1997

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“…In a general population, certain symptoms and historical features have been identified to predict the individuals at highest risk for C. difficile infection. Besides the commonly recognized risk factors for C. difficile infection (antibiotic use and hospitalization) (8), the presence of fecal leukocytes and the presence of semiformed stool were identified as important predictors in a previous study (9). However, the utility of clinical findings and appropriate history is limited in IBD.…”

Section: Ajg -September 2001mentioning

confidence: 99%

Failure of single-toxin assays to detect Clostridium difficile infection in pediatric inflammatory bowel disease

Markowitz

Brown

Mamula

et al. 2001

The American Journal of Gastroenterology

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OBJECTIVES:The aims of this retrospective study were 1) to determine the ability of single-toxin assays for Clostridium difficile to detect infection among pediatric patients with inflammatory bowel disease (IBD) and 2) to determine the toxin assays routinely used by pediatric tertiary care hospitals in the United States. METHODS:Stool specimens from patients with IBD (submitted from January, 1996, to August, 1999 were evaluated for the presence of C. difficile toxin A and toxin B. Toxin profile (toxin A alone, toxin B alone, toxin A and B together) was compared in positive specimens. A phone interview was conducted with representatives from laboratories in 22 pediatric hospitals to investigate which toxin assays were routinely used. RESULTS:A total of 697 specimens were submitted from 284 IBD patients. In all, 81 IBD patients (28.5%) had at least one documented infection. Toxin A assay failed to identify 41.5% of C. difficile infections. Toxin B assay failed to detect 34.9% of C. difficile infections. Toxin profile changed in 55% of patients with multiple infections. Of the hospitals surveyed, 59% did not test for both toxins. CONCLUSIONS:Single-toxin assays for C. difficile fail to detect a significant percentage of infections. The toxins identified during one infection are not predictive of the toxins identified in subsequent infections. Despite this, many pediatric hospitals do not routinely use both toxin assays to diagnose C. difficile infection. When infection is suspected, assays for C. difficile toxin A and toxin B should be requested. (Am J Gastroenterol 2001;96:2688 -2690

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“…При лихорадке, нарастании лейкоцитоза в крови, появления лейкоцитов в кале нужно запо-дозрить ПМК, при котором, несмотря на прекращение антибио-тикотерапии, в большинстве случаев частота стула растет, появ-ляются дегидратация и гипопротеинемия. В тяжелых случаях ПМК быстро наступает обезвоживание, развиваются токсиче-ское расширение и перфорация толстой кишки, возможен ле-тальный исход [23][24][25].…”

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Place of probiotics in the prevention and treatment of antibiotic-associated diarrhea

2015

Ter. arkh.

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Clostridium difficile Colitis: An Efficient Clinical Approach to Diagnosis

Cited by 168 publications

References 0 publications

Predicting Clostridium difficile Stool Cytotoxin Results in Hospitalized Patients with Diarrhea

Predicting Clostridium difficile Stool Cytotoxin Results in Hospitalized Patients with Diarrhea

Failure of single-toxin assays to detect Clostridium difficile infection in pediatric inflammatory bowel disease

Place of probiotics in the prevention and treatment of antibiotic-associated diarrhea

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