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839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals
BACKGROUND: Guidelines support the use of toxin tests after C. difficile antigen detection or nucleic acid amplification tests (e.g., PCR) to help clinicians distinguish colonization from infection and reduce overdiagnosis but the safety of toxin-based diagnostic approaches remains controversial. ME...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809020/ http://dx.doi.org/10.1093/ofid/ofz359.024 |
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author | Polage, Christopher R Grein, Jonathan Morgan, Margie Doernberg, Sarah B Miller, Steve Chinn, Raymond Woerle, Cathy Yim, Jennifer Bittencourt, Cassiana Krishna, Sneha Anne Ocampo, Nicolle Gibbs, Laurel Mabalot, Shannon C Quan, Kathleen A Khusbu, Usme Madey, Keith M Ganzon, Czarina Memar, Fatemeh Pascual, Christian B Cohen, Stuart Liu, Catherine Yokoe, Deborah S Huang, Susan S |
author_facet | Polage, Christopher R Grein, Jonathan Morgan, Margie Doernberg, Sarah B Miller, Steve Chinn, Raymond Woerle, Cathy Yim, Jennifer Bittencourt, Cassiana Krishna, Sneha Anne Ocampo, Nicolle Gibbs, Laurel Mabalot, Shannon C Quan, Kathleen A Khusbu, Usme Madey, Keith M Ganzon, Czarina Memar, Fatemeh Pascual, Christian B Cohen, Stuart Liu, Catherine Yokoe, Deborah S Huang, Susan S |
author_sort | Polage, Christopher R |
collection | PubMed |
description | BACKGROUND: Guidelines support the use of toxin tests after C. difficile antigen detection or nucleic acid amplification tests (e.g., PCR) to help clinicians distinguish colonization from infection and reduce overdiagnosis but the safety of toxin-based diagnostic approaches remains controversial. METHODS: Five California hospitals monitored hospitalized adults with C. difficile testing before and after operational changes to reduce test-related overdiagnosis (2016–2018). Four added a toxin test to an existing GDH antigen/PCR-based approach and/or changed reporting to encourage the use of toxin results for clinical decision-making (i.e.,“toxin-dominant reporting”). One used the same test (toxin only) and reporting strategy throughout. All used a standardized tool to document clinical outcomes and treatment four days after testing (i.e., Day 5). RESULTS: In total, 1,034 patients had a Day 5 assessment with PCR-dominant reporting (pre-operational changes); 2,511 patients had a Day 5 assessment with toxin-dominant reporting (post-operational changes and single facility with no test change). Fewer Toxin-negative/PCR-positive (Toxin−/PCR+) patients received treatment with toxin-dominant reporting (median change: −52.1% [interquartile range (IQR): −35.1%, −69.1%]; aggregate P < 0.001). Day 5 outcomes were similar or better with toxin-dominant reporting despite less treatment. Patient discharge rates and in hospital diarrheal recovery was greater in the subset of Toxin−/PCR+ patients during the toxin-dominant reporting period: median discharge rate change = 8.8% [IQR: 1.5%, 11.9%] (aggregate P = 0.04); median diarrheal recovery rate change = 11.8% [IQR: 8.8%, 18.2%] (aggregate P = 0.018). CONCLUSION: In a 5-center study, toxin-dominant test result reporting decreased anti-C. difficile treatment and improved discharge rates and diarrheal recovery in Toxin−/PCR+ patients. More work is needed to determine the rate of C. difficile-related adverse events in Toxin−/PCR+ patients. DISCLOSURES: All Authors: No reported Disclosures. |
format | Online Article Text |
id | pubmed-6809020 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68090202019-10-28 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals Polage, Christopher R Grein, Jonathan Morgan, Margie Doernberg, Sarah B Miller, Steve Chinn, Raymond Woerle, Cathy Yim, Jennifer Bittencourt, Cassiana Krishna, Sneha Anne Ocampo, Nicolle Gibbs, Laurel Mabalot, Shannon C Quan, Kathleen A Khusbu, Usme Madey, Keith M Ganzon, Czarina Memar, Fatemeh Pascual, Christian B Cohen, Stuart Liu, Catherine Yokoe, Deborah S Huang, Susan S Open Forum Infect Dis Abstracts BACKGROUND: Guidelines support the use of toxin tests after C. difficile antigen detection or nucleic acid amplification tests (e.g., PCR) to help clinicians distinguish colonization from infection and reduce overdiagnosis but the safety of toxin-based diagnostic approaches remains controversial. METHODS: Five California hospitals monitored hospitalized adults with C. difficile testing before and after operational changes to reduce test-related overdiagnosis (2016–2018). Four added a toxin test to an existing GDH antigen/PCR-based approach and/or changed reporting to encourage the use of toxin results for clinical decision-making (i.e.,“toxin-dominant reporting”). One used the same test (toxin only) and reporting strategy throughout. All used a standardized tool to document clinical outcomes and treatment four days after testing (i.e., Day 5). RESULTS: In total, 1,034 patients had a Day 5 assessment with PCR-dominant reporting (pre-operational changes); 2,511 patients had a Day 5 assessment with toxin-dominant reporting (post-operational changes and single facility with no test change). Fewer Toxin-negative/PCR-positive (Toxin−/PCR+) patients received treatment with toxin-dominant reporting (median change: −52.1% [interquartile range (IQR): −35.1%, −69.1%]; aggregate P < 0.001). Day 5 outcomes were similar or better with toxin-dominant reporting despite less treatment. Patient discharge rates and in hospital diarrheal recovery was greater in the subset of Toxin−/PCR+ patients during the toxin-dominant reporting period: median discharge rate change = 8.8% [IQR: 1.5%, 11.9%] (aggregate P = 0.04); median diarrheal recovery rate change = 11.8% [IQR: 8.8%, 18.2%] (aggregate P = 0.018). CONCLUSION: In a 5-center study, toxin-dominant test result reporting decreased anti-C. difficile treatment and improved discharge rates and diarrheal recovery in Toxin−/PCR+ patients. More work is needed to determine the rate of C. difficile-related adverse events in Toxin−/PCR+ patients. DISCLOSURES: All Authors: No reported Disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809020/ http://dx.doi.org/10.1093/ofid/ofz359.024 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Polage, Christopher R Grein, Jonathan Morgan, Margie Doernberg, Sarah B Miller, Steve Chinn, Raymond Woerle, Cathy Yim, Jennifer Bittencourt, Cassiana Krishna, Sneha Anne Ocampo, Nicolle Gibbs, Laurel Mabalot, Shannon C Quan, Kathleen A Khusbu, Usme Madey, Keith M Ganzon, Czarina Memar, Fatemeh Pascual, Christian B Cohen, Stuart Liu, Catherine Yokoe, Deborah S Huang, Susan S 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title | 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title_full | 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title_fullStr | 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title_full_unstemmed | 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title_short | 839. Effect of Clostridioides difficile (C. difficile) Toxin Test Reporting on Clinical Treatment and Outcomes of Toxin-Negative PCR-Positive Patients at Five California Hospitals |
title_sort | 839. effect of clostridioides difficile (c. difficile) toxin test reporting on clinical treatment and outcomes of toxin-negative pcr-positive patients at five california hospitals |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809020/ http://dx.doi.org/10.1093/ofid/ofz359.024 |
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