Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study

INTRODUCTION AND OBJECTIVE: Diagnostic testing for Clostridioides difficile infection (CDI) by nucleic acid amplification test (NAAT) cannot distinguish between colonization and infection. A positive NAAT may therefore represent a false positive for infection, since diarrhea due to various aetiologi...

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Autores principales: Demir, Koray K., Cheng, Matthew P., Lee, Todd C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281280/
https://www.ncbi.nlm.nih.gov/pubmed/30517148
http://dx.doi.org/10.1371/journal.pone.0207128
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author Demir, Koray K.
Cheng, Matthew P.
Lee, Todd C.
author_facet Demir, Koray K.
Cheng, Matthew P.
Lee, Todd C.
author_sort Demir, Koray K.
collection PubMed
description INTRODUCTION AND OBJECTIVE: Diagnostic testing for Clostridioides difficile infection (CDI) by nucleic acid amplification test (NAAT) cannot distinguish between colonization and infection. A positive NAAT may therefore represent a false positive for infection, since diarrhea due to various aetiologies may occur in hospitalized patients. Our objective was to help answer the question: “does this medical inpatient with diarrhea have CDI?” DESIGN: We conducted a retrospective cohort study (n = 248) on the Clinical Teaching Units of the Royal Victoria Hospital (Montréal, Canada). Patients were included if they had a NAAT between January 2014 and September 2015 and their admission diagnosis was not CDI. CDI cases and non-CDI cases were compared, and independent predictors of CDI were determined by logistic regression. RESULTS: Several factors were independently associated with CDI, including: hemodialysis (OR: 13.5, 95% CI: 2.85–63.8), atrial fibrillation (OR: 3.70, 95% CI: 1.52–9.01), whether the patient received empiric treatment (OR: 3.01, 95% CI: 1.04–8.68), systemic antibiotic therapy prior to testing (OR: 4.23, 95% CI: 1.71–10.5), previous positive NAAT (OR: 3.70, 95% CI: 1.41–9.72), and a leukocyte count of 11x10(9)/L or higher (OR: 3.43, 95% CI: 1.42–8.26). The area under the curve was 0.80. CONCLUSION: For patients presenting with hospital-onset diarrhea, various parameters can help differentiate between CDI and other causes. A clinical prediction calculator derived from our cohort (http://individual.utoronto.ca/leet/cdiff.html) might assist clinicians in estimating the risk of CDI for inpatients; those with low pre-test probability may not require immediate testing, treatment, nor prolonged isolation.
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spelling pubmed-62812802018-12-20 Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study Demir, Koray K. Cheng, Matthew P. Lee, Todd C. PLoS One Research Article INTRODUCTION AND OBJECTIVE: Diagnostic testing for Clostridioides difficile infection (CDI) by nucleic acid amplification test (NAAT) cannot distinguish between colonization and infection. A positive NAAT may therefore represent a false positive for infection, since diarrhea due to various aetiologies may occur in hospitalized patients. Our objective was to help answer the question: “does this medical inpatient with diarrhea have CDI?” DESIGN: We conducted a retrospective cohort study (n = 248) on the Clinical Teaching Units of the Royal Victoria Hospital (Montréal, Canada). Patients were included if they had a NAAT between January 2014 and September 2015 and their admission diagnosis was not CDI. CDI cases and non-CDI cases were compared, and independent predictors of CDI were determined by logistic regression. RESULTS: Several factors were independently associated with CDI, including: hemodialysis (OR: 13.5, 95% CI: 2.85–63.8), atrial fibrillation (OR: 3.70, 95% CI: 1.52–9.01), whether the patient received empiric treatment (OR: 3.01, 95% CI: 1.04–8.68), systemic antibiotic therapy prior to testing (OR: 4.23, 95% CI: 1.71–10.5), previous positive NAAT (OR: 3.70, 95% CI: 1.41–9.72), and a leukocyte count of 11x10(9)/L or higher (OR: 3.43, 95% CI: 1.42–8.26). The area under the curve was 0.80. CONCLUSION: For patients presenting with hospital-onset diarrhea, various parameters can help differentiate between CDI and other causes. A clinical prediction calculator derived from our cohort (http://individual.utoronto.ca/leet/cdiff.html) might assist clinicians in estimating the risk of CDI for inpatients; those with low pre-test probability may not require immediate testing, treatment, nor prolonged isolation. Public Library of Science 2018-12-05 /pmc/articles/PMC6281280/ /pubmed/30517148 http://dx.doi.org/10.1371/journal.pone.0207128 Text en © 2018 Demir et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Demir, Koray K.
Cheng, Matthew P.
Lee, Todd C.
Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title_full Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title_fullStr Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title_full_unstemmed Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title_short Predictive factors of Clostridioides difficile infection in hospitalized patients with new diarrhea: A retrospective cohort study
title_sort predictive factors of clostridioides difficile infection in hospitalized patients with new diarrhea: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281280/
https://www.ncbi.nlm.nih.gov/pubmed/30517148
http://dx.doi.org/10.1371/journal.pone.0207128
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