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Trends in Clostridioides difficile diagnosis before and after a change in testing algorithm.

David P Turner1, Samuel J Thorburn2, Amy Crowe1

  • 1Department of Microbiology & Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Australia.

Journal of Microbiological Methods
|March 10, 2021
PubMed
Summary
This summary is machine-generated.

A two-step diagnostic algorithm for Clostridioides difficile (CD) infection is more effective than nucleic acid amplification testing (NAAT) alone. This approach better identifies patients with actual CD disease, reducing unnecessary treatment for colonization.

Keywords:
Antimicrobial stewardshipClostridioides difficile infectionsDiarrheaHealth care associated-infectionsTesting algorithms

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Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Diagnostic strategies

Background:

  • Clostridioides difficile (CD) infection diagnosis is complex in hospitalized patients due to various testing methods and differential diagnoses for diarrhea.
  • Current diagnostic approaches, such as nucleic acid amplification testing (NAAT) alone, may lead to overdiagnosis and overtreatment of CD colonization.

Purpose of the Study:

  • To compare the diagnostic yield of a two-step testing algorithm versus NAAT alone for Clostridioides difficile (CD) infection in hospitalized patients.
  • To assess the correlation between diagnostic test results and clinical presentation, risk factors, and treatment outcomes.

Main Methods:

  • Retrospective analysis of 100 consecutive inpatients with positive CD testing at a tertiary center.
  • Comparison of a two-step algorithm (Glutamate Dehydrogenase enzyme immunoassays followed by toxin enzyme immunoassay) with NAAT alone.

Main Results:

  • The two-step algorithm identified patients with clinically consistent CD disease significantly more often than NAAT alone.
  • No increase in severe CD disease cases was observed with the two-step algorithm.
  • NAAT alone was associated with an increased rate of unnecessary treatment for CD colonization.

Conclusions:

  • A two-step diagnostic algorithm improves the accuracy of Clostridioides difficile (CD) infection diagnosis in hospitalized patients.
  • Implementing a two-step approach can help differentiate between active CD infection and colonization, potentially reducing overtreatment.
  • This strategy enhances clinical correlation and optimizes patient management for CD infections.