Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C difficile infection
Tim Planche,Kerrie Davies,Pietro G Coen,John Finney,Irene M. Monahan,K. Morris,Lily O’Connor,Sarah Oakley,Cassie F Pope,Mike W Wren,Nandini Shetty,Derrick W. Crook,Mark H. Wilcox +12 more
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A new diagnostic category of potential C difficile excretor (cytotoxigenic culture positive but cytotoxin assay negative) could be used to characterise patients with diarrhoea that is probably not due to C diffICile infection, but who can cause cross-infection.Abstract:
Summary Background Diagnosis of Clostridium difficile infection is controversial because of many laboratory methods, compounded by two reference methods. Cytotoxigenic culture detects toxigenic C difficile and gives a positive result more frequently (eg, because of colonisation, which means that individuals can have the bacterium but no free toxin) than does the cytotoxin assay, which detects preformed toxin in faeces. We aimed to validate the reference methods according to clinical outcomes and to derive an optimum laboratory diagnostic algorithm for C difficile infection. Methods In this prospective, multicentre study, we did cytotoxigenic culture and cytotoxin assays on 12 420 faecal samples in four UK laboratories. We also performed tests that represent the three main targets for C difficile detection: bacterium (glutamate dehydrogenase), toxins, or toxin genes. We used routine blood test results, length of hospital stay, and 30-day mortality to clinically validate the reference methods. Data were categorised by reference method result: group 1, cytotoxin assay positive; group 2, cytotoxigenic culture positive and cytotoxin assay negative; and group 3, both reference methods negative. Findings Clinical and reference assay data were available for 6522 inpatient episodes. On univariate analysis, mortality was significantly higher in group 1 than in group 2 (72/435 [16·6%] vs 20/207 [9·7%], p=0·044) and in group 3 (503/5880 [8·6%], p Interpretation We noted no increase in mortality when toxigenic C difficile alone was present. Toxin (cytotoxin assay) positivity correlated with clinical outcome, and so this reference method best defines true cases of C difficile infection. A new diagnostic category of potential C difficile excretor (cytotoxigenic culture positive but cytotoxin assay negative) could be used to characterise patients with diarrhoea that is probably not due to C difficile infection, but who can cause cross-infection. Funding Department of Health and Health Protection Agency, UK.read more
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Incidence, epidemiology and control of Clostridium difficile infection in a tertiary care private hospital in India.
TL;DR: CDI is an emerging HAI in India and all hospitals need to set up policies for surveillance, testing, treatment and prevention of CDI based on recent international guidelines and local infrastructure/logistics.
Journal ArticleDOI
Prevalence of Clostridium difficile infection in acute care hospitals, long-term care facilities, and outpatient clinics: Is Clostridium difficile infection underdiagnosed in long-term care facility patients?
Amar Krishna,Amina Pervaiz,Paul R. Lephart,Noor Tarabishy,Swapna Varakantam,Aditya Kotecha,Reda A. Awali,Keith S. Kaye,Teena Chopra +8 more
TL;DR: There is a critical need to educate LTCF staff to send diarrheal stool for C difficile testing to identify more cases and prevent transmission.
Journal ArticleDOI
WGS to determine the extent of Clostridioides difficile transmission in a high incidence setting in North Wales in 2015.
David W Eyre,Robert Shaw,Helen Adams,Tracey Cooper,Derrick W. Crook,Rhonda-Marie Griffin,Phil Mannion,Mari Morgan,Trefor Morris,Michael D. Perry,Sophie Jones,Tim E. A. Peto,Jonathan Sutton,A. Sarah Walker,Dafydd Williams,Noel Craine +15 more
TL;DR: Levels of transmission detected by WGS were comparable to previously described rates in endemic settings; other explanations, such as variations in antimicrobial use, are required to explain the high levels of CDI.
Journal ArticleDOI
PCR Cycle-Threshold-Derived Toxin Identifies Patients at Low-Risk for Complications of C. difficile Infection Who Do Not Require Treatment
TL;DR: This study demonstrates the impact of stand-alone PCR assay with toxin prediction on reducing CDI therapy rates and provides further evidence that PCR+/toxin- patients are at low risk for CDI-related complications and do not require treatment, though more data is needed in transplant populations.
Journal ArticleDOI
South African Society of Clinical Microbiology Clostridioides difficile infection diagnosis, management and infection prevention and control guideline.
Trusha Nana,Chanelle Moore,Tom H. Boyles,Adrian Brink,Joy Cleghorn,Lesley M. Devenish,Briette du Toit,Ernst Fredericks,Molebogeng R. Lekalakala-Mokaba,Caroline Maluleka,Muhammad N. Rajabally,Gary Reubenson,Liliwe Shuping,Karin Swart,Khine Swe Swe Han,Jeannette Wadula,Justyna Wojno,Warren Lowman +17 more
TL;DR: This guideline provides evidence-based practical recommendations for South Africa and other developing countries on CDI diagnostic approaches; adult, paediatric and special populations treatment options; and surveillance and infection prevention and control recommendations.
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