Real-time polymerase chain reaction (PCR) cycle threshold and <i>Clostridioides difficile</i> infection outcomes

Choi, Byungwoo; Wong, Ken Koon; Dunn, Aaron; Butler, Robert S.; Fraser, Thomas G.; Procop, Gary W.; Richter, Sandra; Isada, Carlos M.; Deshpande, Abhishek

doi:10.1017/ice.2020.1405

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Previous data have revealed that the PCR-Ct can be used to predict the toxin status. 16,17 Although these previous data were able to establish potential threshold cutoff values, they were unable to determine an association with CDI severity or recurrence. 16,17 Our data indicate that as the PCR-Ct increases, the odds of recurrence at 30 days decreased (Table 3).…”

Section: Discussionmentioning

confidence: 97%

“…16,17 Although these previous data were able to establish potential threshold cutoff values, they were unable to determine an association with CDI severity or recurrence. 16,17 Our data indicate that as the PCR-Ct increases, the odds of recurrence at 30 days decreased (Table 3). A lower PCR-Ct could indicate a higher bacterial burden and thus could correlate to a higher amount of toxin production that would be detected by the toxin assay.…”

Section: Discussionmentioning

confidence: 97%

“…8,15 Our PCR-Ct data in contrast to other studies also suggest a predictive value for recurrence. 17,18 A larger prospective study could help determine whether PCR-Ct is truly an effect modifier that is affecting the course of CDI or if it is, instead, a confounder that must be controlled for in multivariable models.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm

Crone

Wright

Cheknis

et al. 2023

Infect. Control Hosp. Epidemiol.

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Background: Polymerase chain reaction (PCR) testing for the detection of C. difficile is a highly sensitive test. Some clinical laboratories have included a 2-step testing algorithm utilizing PCR plus toxin enzyme immunoassays (EIAs) to increase specificity. Objective: To determine the risk factors and outcomes of C. difficile PCR-positive/toxin-positive encounters compared to PCR-positive/toxin-negative encounters. Design: Retrospective study. Setting: A Veterans’ Affairs hospital. Methods: A retrospective case–control study of patient encounters with a positive C. difficile test by PCR and either a toxin EIA–positive assay (ie, cases) or toxin EIA–negative assay (ie, controls). Clinically relevant exposures and risk factors were determined to assess CDI recurrence at 30 days. Available encounter stool specimens were cultured for C. difficile and were subjected to restriction endonuclease analysis (REA) strain typing. Results: Among 130 C. difficile PCR-positive patient encounters, 80 (61.5%) were toxin EIA negative and 50 (38.5%) were toxin EIA positive. Encounters that were toxin positive were more frequently treated (96.0%) compared to toxin-negative encounters (71.3%; P < .01). A multivariable logistic regression model revealed that toxin-negative encounters were less likely to suffer a recurrent CDI episode within 30 days (odds ratio [OR], 0.20, 95% confidence interval [CI], 0.05–0.83). Additionally, a higher C. difficile PCR cycle threshold predicted a lower risk of CDI recurrence at 30 days. (OR, 0.82; 95% CI, 0.68–0.98). During the study period, the REA group Y strain accounted for most toxin-negative encounters (32.5%; P = .05), whereas REA group BI strain accounted for most toxin-positive encounters (24.3%; P = .02). Conclusions: A testing strategy of PCR plus toxin EIA helped predict recurrent CDI.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

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Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm

Crone

Wright

Cheknis

et al. 2023

Infect. Control Hosp. Epidemiol.

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Clostridioides difficile as a Potential Pathogen of Importance to One Health: A Review

Mitchell

Nguyen

Macori

et al. 2022

Foodborne Pathogens and Disease

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GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

et al. 2021

Preprint

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BackgroundClostridioides difficile infection (CDI), its subsequent recurrences (rCDI), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Treatment consists of oral antibiotics. Fidaxomicin, bezlotoxumab and fecal microbiota transplantion (FMT) reduce the number of recurrences compared to vancomycin, but are more costly. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices.ObjectivesIn this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI.MethodsPubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. Study selection was performed by two independent reviewers on the basis of predefined selection criteria; conflicts were resolved by consensus. Cohort and case-control studies providing an analysis of clinical or laboratory data to predict sCDI/rCDI in patients ≥18 years diagnosed with CDI, were included. Risk of bias was assessed with the Quality in Prognostic Research (QUIPS) tool and the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, modified for prognostic studies. Overview tables of prognostic factors were constructed to assess the number of studies and the respective direction of an association (positive, negative, or no association).Results and conclusions136 studies were included for final analysis. Higher age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were higher age, healthcare-associated CDI, prior hospitalization, PPIs started during/after CDI diagnosis and previous rCDI. Some variables that were found as risk factors for sCDI/rCDI in previous reviews were not confirmed in the current review, which can be attributed to differences in methodology. Risk stratification for sCDI/rCDI may contribute to a more personalized and optimal treatment for patients with CDI.

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Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Cited by 3 publications

References 22 publications

Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm

Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm

Clostridioides difficile as a Potential Pathogen of Importance to One Health: A Review

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

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