1887

Abstract

PCR has increasingly replaced toxin A and B enzyme immunoassay (EIA) for the testing of infection (CDI). This study evaluated the clinical outcomes of CDI and disease epidemiology since the introduction of PCR. Clinical data and outcomes for patients admitted to a tertiary care centre during 2003 to 2012 were extracted using electronic medical records. Outcomes and incidence of disease were compared between types of CDI testing. In total, 15.6 % of 108 092 patients admitted were tested for CDI. Among patients tested, 6.1 % had positive results. The mean number of tests performed per 1000 admissions by EIA and PCR was 257.4 and 162.6, respectively. A total of 8.2 % of PCR tests were positive compared to 5.0 % of EIA tests ( < 0.001). The number of tests performed has decreased and the proportion of positive tests increased since PCR introduction. CDI incidence has remained constant. Only albumin (3.09 vs 3.24 g dl,  0.002) and inflammatory bowel disease (2.6  vs 7.0 %,  < 0.001) status differed between the EIA and PCR groups. While hospital mortality did not differ, patients diagnosed by PCR had a shorter median length of stay (10 vs 8 days,  0.004). Since PCR testing began, less CDI tests have been performed, but the proportion of positive results has increased. The incidence of CDI has remained constant, suggesting no change in disease epidemiology. The length of stay was shorter in the PCR group, reflective of either earlier detection and quicker onset of therapy or detection of less severe disease. Mortality did not change since the introduction of PCR.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000126
2015-09-01
2019-12-15
Loading full text...

Full text loading...

/deliver/fulltext/jmm/64/9/1082.html?itemId=/content/journal/jmm/10.1099/jmm.0.000126&mimeType=html&fmt=ahah

References

  1. Catanzaro M., Cirone J.. ( 2012;). Real-time polymerase chain reaction testing for Clostridium difficile reduces isolation time and improves patient management in a small community hospital. Am J Infect Control 40: 663–666 [CrossRef] [PubMed].
    [Google Scholar]
  2. Cecil J. A.. ( 2012;). Clostridium difficile: changing epidemiology, treatment and infection prevention measures. Curr Infect Dis Rep 14: 612–619 [CrossRef] [PubMed].
    [Google Scholar]
  3. Dubberke E. R., Reske K. A., Olsen M. A., McDonald L. C., Fraser V. J.. ( 2008;). Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clin Infect Dis 46: 497–504 [CrossRef] [PubMed].
    [Google Scholar]
  4. Ghantoji S. S., Sail K., Lairson D. R., DuPont H. L., Garey K. W.. ( 2010;). Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 74: 309–318 [CrossRef] [PubMed].
    [Google Scholar]
  5. Grein J. D., Ochner M., Hoang H., Jin A., Morgan M. A., Murthy A. R.. ( 2014;). Comparison of testing approaches for Clostridium difficile infection at a large community hospital. Clin Microbiol Infect 20: 65–69 [CrossRef] [PubMed].
    [Google Scholar]
  6. Kyne L., Hamel M. B., Polavaram R., Kelly C. P.. ( 2002;). Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 34: 346–353 [CrossRef] [PubMed].
    [Google Scholar]
  7. Lipp M. J., Nero D. C., Callahan M. A.. ( 2012;). Impact of hospital-acquired Clostridium difficile. J Gastroenterol Hepatol 27: 1733–1737 [CrossRef] [PubMed].
    [Google Scholar]
  8. Miller B. A., Chen L. F., Sexton D. J., Anderson D. J.. ( 2011;). Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 32: 387–390 [CrossRef] [PubMed].
    [Google Scholar]
  9. Moehring R. W., Lofgren E. T., Anderson D. J.. ( 2013;). Impact of change to molecular testing for Clostridium difficile infection on healthcare facility-associated incidence rates. Infect Control Hosp Epidemiol 34: 1055–1061 [CrossRef] [PubMed].
    [Google Scholar]
  10. Peery A. F., Dellon E. S., Lund J., Crockett S. D., McGowan C. E., Bulsiewicz W. J., Gangarosa L. M., Thiny M. T., Stizenberg K., other authors. ( 2012;). Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143: 1179–1187 [CrossRef] [PubMed].
    [Google Scholar]
  11. Redelings M. D., Sorvillo F., Mascola L.. ( 2007;). Increase in Clostridium difficile-related mortality rates, United States, 1999–2004. Emerg Infect Dis 13: 1417–1419 [CrossRef] [PubMed].
    [Google Scholar]
  12. Tartof S. Y., Yu K. C., Wei R., Tseng H. F., Jacobsen S. J., Rieg G. K.. ( 2014;). Incidence of polymerase chain reaction-diagnosed Clostridium difficile in a large high-risk cohort, 2011-2012. Mayo Clin Proc 89: 1229–1238 [CrossRef] [PubMed].
    [Google Scholar]
  13. Zilberberg M. D., Shorr A. F., Kollef M. H.. ( 2008;). Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis 14: 929–931 [CrossRef] [PubMed].
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000126
Loading
/content/journal/jmm/10.1099/jmm.0.000126
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error