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Consequences of applying two-step or three-step/multistep algorithm in the diagnosis of Clostridioides difficile
Virginia Vilar-García1, M Carmen Domínguez-Jiménez1, Álvaro Pascual2
1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
Introduction:
Toxigenic Clostridioides difficile (CDI) is a leading cause of nosocomial infection. To optimize the diagnosis of this infection, several algorithms have been proposed: in the two-step algorithm, the first step involves the detection of glutamate dehydrogenase (GDH), while in the three-step/multistep algorithm, GDH and toxins are detected simultaneously.
Methods:
Between January 2023 and April 2025, immunochromatography (ICT) was used to detect GDH and toxins A/B in stool samples from patients with suspected CDI, with PCR used as a confirmatory test. The number of CDI cases that would be reported according to each algorithm was compared.
Results:
The application of the three-step/multistep algorithm generated 135 additional positive cases compared to the two-step algorithm, representing a 36.9% increase.
Conclusion:
The diagnostic algorithm for CDI needs to be reviewed when using ICT as the initial test to avoid potential overdiagnosis.
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