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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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2018
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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. |
format | Online Article Text |
id | pubmed-6281280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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