Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management?

Barbut, Frédéric; Surgers, Laure; Eckert, Catherine; Visseaux, Benoît; Cuingnet, M.; Mesquita, Cláudio Tinoco; Pradier, N.; Thiriez, A.; Aït-Ammar, Nawel; Aifaoui, Aissa; Grandsire, E.; Lalande, V.

doi:10.1111/1469-0691.12221

Cited by 71 publications

(52 citation statements)

References 27 publications

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“…The small rate of less than 8% for contact between a confirmed case of CDI and other patients concurs to the idea that the rapid implementation of isolation measures has a beneficial role against spreading of the disease, controlling the transmission of C. difficile [30]. We stress on the significance of low threshold for CD testing in a surgical unit, providing an early diagnostic with excellent results in CD eradication, mortality and morbidity.…”

Section: Discussionsupporting

confidence: 76%

“…We need to take into account that the median stay in the oncology clinic is only 3 days. It is statistically proven that hospital stays longer than 10 days increase the risk of exposure and a transfer from a medical ward is a significant parameter for CDI [10].The small rate of less than 8% for contact between a confirmed case of CDI and other patients concurs to the idea that the rapid implementation of isolation measures has a beneficial role against spreading of the disease, controlling the transmission of C. difficile [30]. We stress on the significance of low threshold for CD testing in a surgical unit, providing an early diagnostic with excellent results in CD eradication, mortality and morbidity.…”

mentioning

confidence: 92%

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Clostridium Difficile Infection - An Optimistic View

Frunza¹,

Rotundu²,

Morărașu³

et al. 2017

Surgery

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Journal of Surgery IntroductionClostridium difficile is an anaerobic, Gram-positive, spore-forming, toxin-producing bacteria identified as a cause of colitis associated with antibiotic use [1]. Previous exposure to antibiotics is the most important risk factor for CDI, leading to modification of the normal flora of the colon and decreasing the intestine's resistance to colonization [2]. Other risk factors for CDI are inflammatory bowel disease, immunodeficiency, hypoalbuminemia, malignancies, organ transplantation and mechanical bowel preparation. Despite the development of CDI therapy there is a growing incidence, severity, mortality and recurrence of this condition [3]. The high rate of recurrent CDI raises a question mark over current treatment recommendations of the first episodes of CDI [4,5]. Materials and MethodsWe identified all reported cases of CDI during the period of 2014-2016 using the digital database of the center for control, surveillance, and prevention of transmissible diseases in the Regional Oncologic Institute Iasi. All cases are registered in the database immediately after diagnosis, followed by epidemiological investigation and standardized protocols for isolation and protection of contacts. The admission charts were studied to extract the following information: age, sex, date of admission and release, date of CDI confirmation and toxin negativity. We also checked for antibiotic use in the last 3 months, administration of gastricantisecretory medication, previous hospitalization or contact with CDIconfirmed patients. For the surgical cases we gathered data about the date and type of intervention performed. Diagnosis of Clostridium difficile colitisEven if symptoms can be variable, typical symptom is watery diarrhea up to 15-30 stools per day [1,3]. Some patients can complain AbstractBackground: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit. Materials and methods:We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B. Results:The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influen...

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 92%

Clostridium Difficile Infection - An Optimistic View

Frunza¹,

Rotundu²,

Morărașu³

et al. 2017

Surgery

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“…13 reducing delays in testing may improve the quality of patient management [40]. Several recent studies have demonstrated that real-time PCR for toxin B gene has a high sensitivity and specificity in detecting CDI [7,10].…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Accuracy of loop-mediated isothermal amplification for the diagnosis of Clostridium difficile infection: a systematic review

Lloyd

Pasupuleti

Thota

et al. 2015

Diagnostic Microbiology and Infectious Disease

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CitationLloyd A, Pasupuleti V, Thota P, Pant C, Rolston DDK, Hernandez A V., et al. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT

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“…One recent study shows that the number of unnecessary days of contact precaution and unjustified antibiotic usage decreased by nearly 40% for those patients who were diagnosed as negative for CDI by molecular testing compared to those diagnosed with CCNA or enhanced cell culture. The same study showed that the use of molecular testing decreased the length of hospitalization on average by more than 7 days compared to that for CCNA or enhanced cell culture (6).…”

mentioning

confidence: 88%

“…The increased economic burden in hospitalized patients due to CDI has been estimated at $9,822 to $13,854 per patient, and total patient costs (health care costs plus lost wages) associated with CDI have been estimated to exceed $1 billion annually in the United States alone (3,4). Several recent studies have demonstrated that rapid and accurate detection of C. difficile is an important component of combating hospital-acquired CDI and can have a significant benefit to patients and hospitals from a financial and clinical perspective (4)(5)(6).…”

mentioning

confidence: 99%

Multicenter Evaluation of the Quidel Lyra Direct C. difficile Nucleic Acid Amplification Assay

Beck¹,

Buchan

Riebe³

et al. 2014

J Clin Microbiol

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dClostridium difficile is a Gram-positive bacterium commonly found in health care and long-term-care facilities and is the most common cause of antibiotic-associated diarrhea. Rapid detection of this bacterium can assist physicians in implementing contact precautions and appropriate antibiotic therapy in a timely manner. The purpose of this study was to compare the clinical performance of the Quidel Lyra Direct C. difficile assay (Lyra assay) (Quidel, San Diego, CA) to that of a direct cell culture cytotoxicity neutralization assay (CCNA) and enhanced toxigenic culture. This study was performed at three geographically diverse laboratories within the United States using residual stool specimens submitted for routine C. difficile testing. Residual samples were tested using the Lyra assay on three real-time PCR platforms, and results were compared to those for direct CCNA and enhanced toxigenic culture. The test results for all platforms were consistent across all three test sites. The sensitivity and specificity of the Lyra assay on the SmartCycler II, ABI 7500 Fast DX, and ABI QuantStudio DX instruments compared to CCNA were 90.0% and 93.3%, 95.0% and 94.2%, and 93.8% and 95.0%, respectively. Compared to enhanced toxigenic culture, the sensitivity and specificity of the Lyra assay on the SmartCycler II, ABI 7500, and QuantStudio instruments were 82.1% and 96.9%, 89.3% and 98.8%, and 85.7% and 99.0%, respectively. Overall, the Lyra assay is easy to use and versatile and compares well to C. difficile culture methods.

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Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management?

Cited by 71 publications

References 27 publications

Clostridium Difficile Infection - An Optimistic View

Clostridium Difficile Infection - An Optimistic View

Accuracy of loop-mediated isothermal amplification for the diagnosis of Clostridium difficile infection: a systematic review

Multicenter Evaluation of the Quidel Lyra Direct C. difficile Nucleic Acid Amplification Assay

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