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Real-world evaluation of a two-step testing algorithm for Clostridioides difficile infection.

Michelle T Hecker1,2, Andrea H Son3, Patricia Zuccaro1

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Infection Control and Hospital Epidemiology
|February 7, 2023
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Summary

Most patients with suspected Clostridioides difficile infection (CDI) and discordant test results (NAAT+/TOX-) received treatment. Over 70% of these patients were classified as having probable or possible CDI.

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Diagnostic Testing

Background:

  • Clostridioides difficile infection (CDI) diagnosis relies on clinical symptoms and laboratory tests.
  • A 2-step testing algorithm, combining nucleic acid amplification tests (NAAT) and toxin assays, is commonly used.
  • Discordant results (NAAT-positive, toxin-negative) present diagnostic challenges.

Purpose of the Study:

  • To evaluate the treatment patterns for patients with suspected CDI and discordant NAAT+/TOX- results.
  • To assess the classification of CDI probability in patients with NAAT+/TOX- results.

Main Methods:

  • Retrospective analysis of patients with suspected CDI over a 4-year period.
  • Evaluation of a 2-step diagnostic algorithm (NAAT and toxin testing).
  • Analysis of treatment decisions and CDI classification for NAAT+/TOX- cases.

Main Results:

  • 70% to 78% of patients with NAAT+/TOX- results received CDI treatment.
  • Approximately 73% of NAAT+/TOX- patients were classified as having probable or possible CDI.
  • The study highlights treatment trends in a specific diagnostic scenario.

Conclusions:

  • A significant proportion of patients with NAAT+/TOX- results are treated for CDI.
  • The 2-step algorithm's utility in guiding treatment for ambiguous cases warrants further investigation.
  • Clinical judgment likely plays a role in managing patients with discordant CDI test results.