Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Guh, Alice Y. ; Fridkin, Scott ; Goodenough, Dana ; Winston, Lisa G. ; Johnston, Helen ; Basiliere, Elizabeth ; Olson, Danyel ; Wilson, Christopher D. ; Watkins, Jasmine J. ; Korhonen, Lauren ; Gerding, Dale N.
• Description:
  Objective:
  
  Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (−). We compared NAAT+/toxin− and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin− patients.
  
  Design:
  
  Retrospective observational study.
  
  Setting:
  
  The study was conducted across 36 laboratories at 5 Emerging Infections Program sites.
  
  Patients:
  
  We defined a CDI case as a positive test detected by this 2-step algorithm during 2018–2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks.
  
  Methods:
  
  We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin− and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin− cases.
  
  Results:
  
  Of 1,801 cases, 1,252 were NAAT+/toxin−, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin− cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin− status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55–0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87–1.28). Among NAAT+/toxin− cases, white blood cell count ≥15,000/μL (aOR, 1.87; 95% CI, 1.28–2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40–2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23–4.68) were predictors of CDI treatment.
  
  Conclusion:
  
  Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin− cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin− cases.
  
  
• Subjects:
  Algorithms Bacterial Toxins Clostridioides Difficile Clostridium Infections Enterotoxins Humans Nucleic Acid Amplification Techniques
• Source:
  Infect Control Hosp Epidemiol. 45(5):590-598
• Pubmed ID:
  38268440
• Pubmed Central ID:
  PMC11027077
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  45
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:716c2d07209dc18711286d1496356cacc062a0790e52b3f9982b8b6a55091dc6
• Download URL:
  https://stacks.cdc.gov/view/cdc/154702/cdc_154702_DS1.pdf
• File Type:
  [PDF - 493.96 KB ]