Clostridium difficile rates in asymptomatic and symptomatic hospitalized patients using nucleic acid testing

Truong, Cynthia; Schroeder, Lee F.; Gaur, Rajiv L.; Anikst, Victoria; Komo, Ikuko; Watters, Colleen; McCalley, Erin; Kulik, Carole; Pickham, David; Lee, Nancy J.; Banaei, Niaz

doi:10.1016/j.diagmicrobio.2016.12.014

Cited by 33 publications

(26 citation statements)

References 38 publications

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“…A screening study in ICU patients showed that while about 10% of a total number of 922 patients tested positive for C. difficile by NAAT, only about 3% developed a symptomatic disease [ 22 ]. Recent data confirmed that 11.8% of asymptomatic patients and 15.4% of symptomatic patients are found positive for C. difficile using a NAAT test [ 23 ].…”

Section: Diagnosismentioning

confidence: 88%

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

et al. 2017

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Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4–4% and has severe impact on morbidity and mortality. An estimated 10–20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens.Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient.First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.

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Section: Diagnosismentioning

confidence: 88%

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

et al. 2017

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“…The asymptomatic colonization rate of toxigenic C. difficile in hospitalized adult patients was found to range from 3% to 20%, but this is higher (24%–55%) in infants and young children …”

Section: Introductionmentioning

confidence: 99%

“…8 Furthermore, typing studies have found that only a small proportion of CDI is linked to nosocomial transmission. [9][10][11] The asymptomatic colonization rate of toxigenic C. difficile in hospitalized adult patients was found to range from 3% to 20%, [12][13][14][15] but this is higher (24%-55%) in infants and young children. 16,17 Children and adolescents undergoing therapy for cancer are at high risk for CDI due to exposure to several known CDI risk factors including profound myelosuppression and broad-spectrum antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Al‐Rawahi

Alnajjar

McDonald

et al. 2019

Pediatric Blood & Cancer

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Clostridium difficile is the leading cause of healthcare‐associated infections worldwide. The diagnosis of C. difficile infection (CDI) in pediatric oncology patients is complex as diarrhea is common, and there is a high rate of colonization in infants and young children. This study was conducted to assess the accuracy of the surveillance definitions of healthcare‐associated CDI (HA‐CDI) and to determine the prevalence of toxigenic C. difficile colonization among pediatric oncology and stem cell transplant patients. Methods A prospective cohort study was conducted over a three‐year period in an inpatient pediatric oncology and stem cell transplant setting. Baseline stool samples were collected within three days of admission and were genotypically compared with clinically indicated samples submitted after three days of admission. Results A total of 175 patients were recruited with a total of 536 admissions. The adjusted prevalence of baseline toxigenic C. difficile colonization among admissions was 32.8%. Seventy‐eight percent of positive admissions did not have history of CDI. Colonization with a toxigenic strain on admission was predictive of CDI (OR = 28.6; 95% CI, 6.58–124.39; P < 0.001). Nearly all clinical isolates (8/9) shared identical pulsed‐field gel electrophoresis patterns with baseline isolates or were closely related (1/9). Only one of the 11 cases that were considered HA‐CDI was potentially nosocomially acquired. Conclusion The prevalence of colonization with toxigenic C. difficile in our cohort is high. Unfortunately, the current CDI surveillance definitions overestimate the incidence of HA‐CDI in pediatric oncology and stem cell transplantation settings.

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“…The overall effect of our intervention was a significant decrease in health care-onset health care facility-associated CDI (HO-CDI) rates and vancomycin utilization without a significant increase in CDI-related complications in patients with tests canceled for not meeting the intervention testing criteria. Studies indicate that 4.4% to 21% of hospitalized patients are asymptomatically colonized with toxigenic C. difficile (3)(4)(5)(6)(7)(8)(9)(10)30). Given the inability of C. difficile diagnostics to distinguish between asymptomatic carriage and disease state, our intervention represents an important step toward reducing CDI overdiagnosis and lowering the inflated HO-CDI rates.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

et al. 2017

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Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [Ն3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P Ͻ 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P ϭ 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P ϭ 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Realtime electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.KEYWORDS Clostridium difficile, data tracking, evidence-based medicine, verification C lostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea (1). Clostridium difficile infection (CDI) is estimated to be the most expensive health care-associated infection, costing the U.S. health system $5.4 billion annually (2). A major challenge with accurate diagnosis of CDI is the high prevalence of C. difficile colonization. Studies indicate that 4.4% to 21% of hospitalized patients are asymptomatically colonized with toxigenic C. difficile (3-10, 30). In the absence of disease-specific

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Clostridium difficile rates in asymptomatic and symptomatic hospitalized patients using nucleic acid testing

Cited by 33 publications

References 38 publications

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

Pediatric oncology and stem cell transplant patients with healthcare‐associated Clostridium difficile infection were already colonized on admission

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

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