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Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection

Our aim was to determine changes in the incidence of CD infection (CDI) following the introduction of a two-step diagnostic algorithm and to analyze CDI cases diagnosed in the study period. We retrospectively studied CDI (January 2009 to July 2018) in adults diagnosed by toxin enzyme immunoassay (EI...

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Autores principales: Sopena, Nieves, Wang-Wang, Jun Hao, Casas, Irma, Mateu, Lourdes, Castellà, Laia, García-Quesada, María José, Gutierrez, Sara, Llibre, Josep M., Pedro-Botet, M. Luisa, Fernandez-Rivas, Gema
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144429/
https://www.ncbi.nlm.nih.gov/pubmed/35630517
http://dx.doi.org/10.3390/microorganisms10051075
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author Sopena, Nieves
Wang-Wang, Jun Hao
Casas, Irma
Mateu, Lourdes
Castellà, Laia
García-Quesada, María José
Gutierrez, Sara
Llibre, Josep M.
Pedro-Botet, M. Luisa
Fernandez-Rivas, Gema
author_facet Sopena, Nieves
Wang-Wang, Jun Hao
Casas, Irma
Mateu, Lourdes
Castellà, Laia
García-Quesada, María José
Gutierrez, Sara
Llibre, Josep M.
Pedro-Botet, M. Luisa
Fernandez-Rivas, Gema
author_sort Sopena, Nieves
collection PubMed
description Our aim was to determine changes in the incidence of CD infection (CDI) following the introduction of a two-step diagnostic algorithm and to analyze CDI cases diagnosed in the study period. We retrospectively studied CDI (January 2009 to July 2018) in adults diagnosed by toxin enzyme immunoassay (EIA) (2009–2012) or toxin-EIA + polymerase chain reaction (PCR) algorithm (2013 onwards). A total of 443 patients with a first episode of CDI were included, 297 (67.1%) toxin-EIA-positive and 146 (32.9%) toxin-EIA-negative/PCR-positive were only identified through the two-step algorithm including the PCR test. The incidence of CDI increased from 0.9 to 4.7/10,000 patient-days (p < 0.01) and 146 (32.9%) toxin-negative CDI were diagnosed. Testing rate increased from 24.4 to 59.5/10,000 patient-days (p < 0.01) and the percentage of positive stools rose from 3.9% to 12.5% (p < 0.01). CD toxin-positive patients had a higher frequency of severe presentation and a lower rate of immunosuppressive drugs and inflammatory bowel disease. Mortality (16.3%) was significantly higher in patients with hematological neoplasm, intensive care unit admission and complicated disease. Recurrences (14.9%) were significantly higher with proton pump inhibitor exposure. The two-step diagnostic algorithm facilitates earlier diagnosis, potentially impacting patient outcomes and nosocomial spread. CD-toxin-positive patients had a more severe clinical presentation, probably due to increased CD bacterial load with higher toxin concentration. This early and easy marker should alert clinicians of potentially more severe outcomes.
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spelling pubmed-91444292022-05-29 Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection Sopena, Nieves Wang-Wang, Jun Hao Casas, Irma Mateu, Lourdes Castellà, Laia García-Quesada, María José Gutierrez, Sara Llibre, Josep M. Pedro-Botet, M. Luisa Fernandez-Rivas, Gema Microorganisms Article Our aim was to determine changes in the incidence of CD infection (CDI) following the introduction of a two-step diagnostic algorithm and to analyze CDI cases diagnosed in the study period. We retrospectively studied CDI (January 2009 to July 2018) in adults diagnosed by toxin enzyme immunoassay (EIA) (2009–2012) or toxin-EIA + polymerase chain reaction (PCR) algorithm (2013 onwards). A total of 443 patients with a first episode of CDI were included, 297 (67.1%) toxin-EIA-positive and 146 (32.9%) toxin-EIA-negative/PCR-positive were only identified through the two-step algorithm including the PCR test. The incidence of CDI increased from 0.9 to 4.7/10,000 patient-days (p < 0.01) and 146 (32.9%) toxin-negative CDI were diagnosed. Testing rate increased from 24.4 to 59.5/10,000 patient-days (p < 0.01) and the percentage of positive stools rose from 3.9% to 12.5% (p < 0.01). CD toxin-positive patients had a higher frequency of severe presentation and a lower rate of immunosuppressive drugs and inflammatory bowel disease. Mortality (16.3%) was significantly higher in patients with hematological neoplasm, intensive care unit admission and complicated disease. Recurrences (14.9%) were significantly higher with proton pump inhibitor exposure. The two-step diagnostic algorithm facilitates earlier diagnosis, potentially impacting patient outcomes and nosocomial spread. CD-toxin-positive patients had a more severe clinical presentation, probably due to increased CD bacterial load with higher toxin concentration. This early and easy marker should alert clinicians of potentially more severe outcomes. MDPI 2022-05-23 /pmc/articles/PMC9144429/ /pubmed/35630517 http://dx.doi.org/10.3390/microorganisms10051075 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sopena, Nieves
Wang-Wang, Jun Hao
Casas, Irma
Mateu, Lourdes
Castellà, Laia
García-Quesada, María José
Gutierrez, Sara
Llibre, Josep M.
Pedro-Botet, M. Luisa
Fernandez-Rivas, Gema
Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title_full Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title_fullStr Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title_full_unstemmed Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title_short Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection
title_sort impact of the introduction of a two-step laboratory diagnostic algorithm in the incidence and earlier diagnosis of clostridioides difficile infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144429/
https://www.ncbi.nlm.nih.gov/pubmed/35630517
http://dx.doi.org/10.3390/microorganisms10051075
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