Clinical Characteristics and Outcomes of Hematologic Malignancy Patients With Positive Clostridium difficile Toxin Immunoassay Versus Polymerase Chain Reaction Test Results

Abstract

In a cohort of inpatients with hematologic malignancy and positive enzyme immunoassay (EIA) or polymerase chain reaction (PCR) Clostridium difficile tests, we found that clinical characteristics and outcomes were similar between these groups. The method of testing is unlikely to predict infection in this population, and PCR-positive results should be treated with concern.Infect Control Hosp Epidemiol 2018;863-866.

Oral Vancomycin Prophylaxis Is Highly Effective in Preventing Clostridium difficile Infection in Allogeneic Hematopoietic Cell Transplant Recipients

“…In our institution, the median time to CDI diagnosis was 8 days from admission for alloHCT, which is consistent with previous findings [16,19]. While we did not perform a medical records review to differentiate whether a PCR-positive test was suggestive of infection versus colonization, previous data from our institution suggest that hematologic malignancy patients with enzyme immunoassay-positive and PCR-positive tests have similar rates of signs and symptoms of infections and clinical outcomes [21].…”

Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients

“…However, the decision to treat is up to the clinician, given that some patients in the cited report were treated, the EIA is less sensitive than PCR, and a later study suggested these conclusions may not apply to patients with hematologic malignancies. 29 That only ~30% of PCR(+) stools in our study were EIA(+), similar to the percentage suggested by another report 30 and lower than the 50% hypothesized in our model, bolsters our practice of not referring to the EIA as a confirmatory test. Nonetheless, this 2-step algorithm has reduced the number of people unnecessarily treated for CDI.…”

Evaluation of Cycle Threshold, Toxin Concentration, and Clinical Characteristics of Clostridioides difficile Infection in Patients with Discordant Diagnostic Test Results

“…Although leukocytosis and hypoalbuminemia, which are criteria for severe disease in IDSA guidelines and/or institutional guidelines, were found to be clinically different among most toxin-discordant comparisons, other clinical parameters that indicate severe disease did not differ. While our findings vary depending on the method utilized to classify severe CDI, the available literature is also inconsistent, with some studies showing no difference in severe disease among toxin-discordant patients (12,17) and others finding more severe disease among toxin-positive patients (13,14,16). Furthermore, we did not find a difference in CDI recurrence or mortality among most test-discordant groups, which is discrepant from other studies, likely due to our low incidence of these outcomes and the underpowered nature of the study to detect differences in these outcomes (5,15).…”

“…Several studies have compared clinical presentations and outcomes between toxin-positive CDI and NAATpositive/toxin-negative CDI. However, they have shown conflicting results with respect to CDI severity and recurrence, and mortality (5,(12)(13)(14)(15)(16)(17). Furthermore, definitions of severe disease varied in stringency among the studies.…”