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Two-step algorithm-based Clostridioides difficile testing as a tool for antibiotic stewardship.

Lana Dbeibo1, Christine W Lucky2, William F Fadel3

  • 1Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infection Prevention, Indiana University Health, Indianapolis, IN, USA.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|February 22, 2023
PubMed
Summary

Changing diagnostic methods for Clostridium difficile infection (CDI) and how results are displayed significantly reduced unnecessary antibiotic use. This shift helped differentiate colonization from infection, guiding appropriate treatment decisions.

Keywords:
Antimicrobial stewardshipClostridium difficileDiagnostic stewardshipElectronic medical record

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Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Health services research

Background:

  • Clostridium difficile infection (CDI) diagnosis is complicated by high colonization rates.
  • Distinguishing colonization from active infection is crucial for appropriate treatment.
  • The impact of diagnostic method changes on treatment decisions for CDI is not well understood.

Purpose of the Study:

  • To examine the association between changes in CDI diagnostic methods and result display.
  • To assess the impact of these changes on CDI-specific treatment rates.

Main Methods:

  • Retrospective analysis of 610 positive C. difficile cases over two years.
  • Comparison of treatment rates before and after transitioning from PCR to two-step testing (PCR with toxin testing).
  • Analysis of how results were displayed: 'positive' (PCR era), 'likely colonized', or 'toxin positive' (two-step era).

Main Results:

  • 93% of patients treated in the PCR-only era versus 42% in the 'likely colonized' group and 100% in the 'toxin positive' group.
  • Two-step testing and specific result displays were associated with significantly lower CDI-specific treatment rates (OR 0.05).

Conclusions:

  • Changing diagnostic methods and result displays correlated with reduced CDI-specific antibiotic use.
  • This approach can help differentiate colonization from infection without restricting clinician ordering.
  • Optimized diagnostic strategies can lead to more judicious antibiotic prescribing for CDI.