使用Clostridioides difficile测试算法检查核酸放大测试选的治疗患者的潜在报告不足
Alice Y Guh1, Scott Fridkin2,3, Dana Goodenough2,3,4
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Infection control and hospital epidemiology
|January 25, 2024
概括
两个步骤的Clostridioides difficile感染 (CDI) 测试算法可能会报告不足的病例. 诸如高白细胞计数和便频率等因素会影响NAAT+/毒素患者的治疗决定.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 流行病学 流行病学
背景情况:
- 对于Clostridioides difficile感染 (CDI) 诊断的2步算法包括核酸放大测试 (NAAT),然后进行毒素测试.
- 具有NAAT阳性但毒素阴性 (NAAT+/毒素-) 的患者不会作为实验室识别的CDI事件向国家医疗保健安全网络报告.
- 这种报告差距可能导致CDI流行率的低估,并影响患者管理.
研究的目的:
- 为了比较NAAT+/毒素和NAAT+/毒素+结果的患者之间的结果.
- 确定与NAAT+/毒素患者治疗决策相关的因素.
主要方法:
- 在5个新兴感染项目地点的36个实验室进行了回顾性观察性研究.
- 使用两步算法 (2018-2020) 定义的CDI病例,年龄≥1岁的患者.
- 使用多变量和混合效应逻辑回归来比较结果并确定治疗预测因素.
主要成果:
- 在1,801个病例中,1,252个是NAAT+/毒素,549个是NAAT+/毒素+.
- 与NAAT+/毒素+病例 (95.9%) 相比,NAAT+/毒素+病例中CDI治疗的频率较低 (71.5%).
- NAAT+/毒素状态与复发率较低有关,但与CDI相关的并发症并非如此. 预测NAAT+/毒素治疗的预测因素包括高白细胞计数,频繁不形成的便和实验室解释性评论.
结论:
- 两步算法可能导致临床相关的CDI病例 (NAAT+/毒素-) 报告不足.
- 疾病严重程度指标和实验室报告细微差别影响NAAT+/毒素患者的治疗决策.
- 需要进一步评估两步算法的临床和公共卫生影响.
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