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672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates
BACKGROUND: Clostridioides difficile infection (CDI) is one of the leading causes of hospital-acquired (HA) infections. Clinically distinguishing true CDI versus colonization is challenging. Our center previously used a polymerase chain reaction (PCR) assay as a standalone test for diagnosing CDI. W...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678678/ http://dx.doi.org/10.1093/ofid/ofad500.734 |
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author | Betancourth, Adriana C Gill, Arshpal Bangash, Salman Abalos, Charmaine Bhanot, Nitin Min, Zaw Moffa, Matthew A Shively, Nathan R Walsh, Thomas L |
author_facet | Betancourth, Adriana C Gill, Arshpal Bangash, Salman Abalos, Charmaine Bhanot, Nitin Min, Zaw Moffa, Matthew A Shively, Nathan R Walsh, Thomas L |
author_sort | Betancourth, Adriana C |
collection | PubMed |
description | BACKGROUND: Clostridioides difficile infection (CDI) is one of the leading causes of hospital-acquired (HA) infections. Clinically distinguishing true CDI versus colonization is challenging. Our center previously used a polymerase chain reaction (PCR) assay as a standalone test for diagnosing CDI. While PCR is very sensitive for diagnosing CDI, it cannot distinguish between CDI and asymptomatic colonization. A multistep testing algorithm, which consists of an initial C. difficile PCR test followed by a reflex enzyme immunoassay (EIA) for glutamate dehydrogenase (GDH) and Toxin A/B testing, was implemented in our institution. We conducted this study to determine the rates of HA-CDI and C. difficile colonization based on laboratory results. METHODS: This retrospective observational study was conducted at Allegheny General Hospital (Pittsburgh, PA, US). Patients with a positive C. difficile PCR assay at day 3 or later from admission date were included for analysis. The pre-intervention period was from August 2021 to February 2022 and post-intervention period was from August 2022 to February 2023. Before the intervention, results for C. difficile testing were reported as PCR positive (PCR+) or negative (PCR-). On July 2022, a multistep testing algorithm was implemented with an initial C. difficile PCR assay; if results were positive, a reflex EIA for GDH and Toxin A/B testing was performed and resulted as follows: Figure 1. The HA-CDI rates before and after implementation of a multistep testing algorithm were compared. [Figure: see text] RESULTS: A total of 112 unique patients were included. HA-CDI in the post intervention period decreased by 53% after the intervention (N=57 [pre-intervention] versus N=26 [post-intervention]; P < 0.001). During the post-intervention period, there were 55 PCR+ C. difficile assays, of which 29 (53%) were resulted as "indeterminate, likely C. difficile colonization." Of the 29 indeterminate results, 23 (79%) still received CDI therapy. [Figure: see text] CONCLUSION: Our study demonstrated that a multistep C. difficile testing algorithm significantly reduced the rates of HA-CDI in our institution. We found that the majority of patients still received CDI therapy despite having a negative EIA toxin result. We plan to analyze the clinical impact of this multistep testing algorithm in a follow-up study. DISCLOSURES: Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant |
format | Online Article Text |
id | pubmed-10678678 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106786782023-11-27 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates Betancourth, Adriana C Gill, Arshpal Bangash, Salman Abalos, Charmaine Bhanot, Nitin Min, Zaw Moffa, Matthew A Shively, Nathan R Walsh, Thomas L Open Forum Infect Dis Abstract BACKGROUND: Clostridioides difficile infection (CDI) is one of the leading causes of hospital-acquired (HA) infections. Clinically distinguishing true CDI versus colonization is challenging. Our center previously used a polymerase chain reaction (PCR) assay as a standalone test for diagnosing CDI. While PCR is very sensitive for diagnosing CDI, it cannot distinguish between CDI and asymptomatic colonization. A multistep testing algorithm, which consists of an initial C. difficile PCR test followed by a reflex enzyme immunoassay (EIA) for glutamate dehydrogenase (GDH) and Toxin A/B testing, was implemented in our institution. We conducted this study to determine the rates of HA-CDI and C. difficile colonization based on laboratory results. METHODS: This retrospective observational study was conducted at Allegheny General Hospital (Pittsburgh, PA, US). Patients with a positive C. difficile PCR assay at day 3 or later from admission date were included for analysis. The pre-intervention period was from August 2021 to February 2022 and post-intervention period was from August 2022 to February 2023. Before the intervention, results for C. difficile testing were reported as PCR positive (PCR+) or negative (PCR-). On July 2022, a multistep testing algorithm was implemented with an initial C. difficile PCR assay; if results were positive, a reflex EIA for GDH and Toxin A/B testing was performed and resulted as follows: Figure 1. The HA-CDI rates before and after implementation of a multistep testing algorithm were compared. [Figure: see text] RESULTS: A total of 112 unique patients were included. HA-CDI in the post intervention period decreased by 53% after the intervention (N=57 [pre-intervention] versus N=26 [post-intervention]; P < 0.001). During the post-intervention period, there were 55 PCR+ C. difficile assays, of which 29 (53%) were resulted as "indeterminate, likely C. difficile colonization." Of the 29 indeterminate results, 23 (79%) still received CDI therapy. [Figure: see text] CONCLUSION: Our study demonstrated that a multistep C. difficile testing algorithm significantly reduced the rates of HA-CDI in our institution. We found that the majority of patients still received CDI therapy despite having a negative EIA toxin result. We plan to analyze the clinical impact of this multistep testing algorithm in a follow-up study. DISCLOSURES: Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant Oxford University Press 2023-11-27 /pmc/articles/PMC10678678/ http://dx.doi.org/10.1093/ofid/ofad500.734 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Abstract Betancourth, Adriana C Gill, Arshpal Bangash, Salman Abalos, Charmaine Bhanot, Nitin Min, Zaw Moffa, Matthew A Shively, Nathan R Walsh, Thomas L 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title | 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title_full | 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title_fullStr | 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title_full_unstemmed | 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title_short | 672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates |
title_sort | 672. impact of multistep testing algorithm on hospital acquired clostridioides difficile infection rates |
topic | Abstract |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678678/ http://dx.doi.org/10.1093/ofid/ofad500.734 |
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