scholarly journals 71. Diagnostic Stewardship of Clostridioides difficile Testing

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S153-S153
Author(s):  
Zahra Qamar ◽  
Lisa A Spacek ◽  
Dagan Coppock ◽  
Kaya Patel ◽  
Nathan L’Etoile ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Chain Reaction ◽  
Clostridioides Difficile ◽  
Highly Sensitive ◽  
Significant Difference ◽  
Before And After ◽  
Bowel Movements ◽  
Sensitive Polymerase Chain Reaction ◽  
Polymerase Chain ◽  
Clinically Significant

Abstract Background C. difficile (CD) testing is frequently ordered inappropriately. Highly sensitive polymerase chain reaction (PCR) tests can detect CD colonization leading to misdiagnosis. Providers often overlook other causes of diarrhea, notably laxatives. To improve diagnostic stewardship, our hospital introduced an electronic medical record (EMR)-based order set (OS). Methods In a 926-bed, teaching hospital, we conducted a 3-step intervention to improve CD diagnostic stewardship. (1) A retrospective analysis of CD orders before and after OS implementation was done to assess its impact on inappropriate orders. The OS included two questions: (a) Did patient have ≥ 3 loose bowel movements in past 24 hours? and (b) No laxatives in past 24 hours? An appropriate order was defined if “yes” to both questions. It was still appropriate if “no” to either question but ≥ 2 unexplained following features: fever > 100.4 F, abdominal pain, megacolon, ileus or leukocytosis > 11,000 cells/mm3 in prior day. (2) After implementation of OS, house staff compliance with OS was surveyed via email. (3) Rationale for inappropriate orders was discussed with providers. Results Of 238 patients in retrospective analysis, 44% were ≥ 65 years and 37% had other potential causes of diarrhea. Common clinical features were leukocytosis (40%) and fever (31%). There was no significant difference in inappropriate testing: pre-OS 27/99 (27%) vs post-OS 44/139 (32%) (p=0.47). Of 43 house officers who participated in the survey, 75% indicated they over rode the OS. When asked to provide rationale of inappropriate CD testing, providers acknowledged inappropriate ordering but did not want to miss a CD diagnosis and frequently overlooked other causes of diarrhea. Conclusion Appropriate CD testing relies on providers’ appreciation of a clinical picture consistent with CD infection, confirmation of clinically significant diarrhea, and consideration of other causes of diarrhea. Providers order inappropriate tests, not due to lack of knowledge, but likely fear of missing diagnosis and overlooking other causes of diarrhea. Disclosures All Authors: No reported disclosures

scholarly journals Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses

2017 ◽  
Vol 52 (9) ◽  
pp. 640-644 ◽  
Author(s):  
Sebastian Choi ◽  
Rubiya Kabir ◽  
Pranisha Gautam-Goyal ◽  
Prashant Malhotra
Keyword(s):  
Polymerase Chain Reaction ◽  
Length Of Stay ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
Chain Reaction ◽  
Time Period ◽  
Significant Difference ◽  
Before And After ◽  
Polymerase Chain

Background: Respiratory viral illnesses account for many hospitalizations and inappropriate antibiotic use. Respiratory viral panels by polymerase chain reaction (RVP-PCR) provide a reliable means of diagnosis. In 2015, the RVP-PCR assay at our institution was switched from respiratory viral panel (RVP) to rapid respiratory panel (rapid RP), which has a faster turnaround time (24 hours vs 12 hours, respectively). The purpose of this study was to evaluate the effect of RVP-PCR tests on duration of antibiotic use and length of stay (LOS) in hospitalized patients. Methods: We performed a retrospective chart review of patients who had a RVP-PCR ordered within a 1-year time period before and after the assay switch. Patients who were pregnant, had received antibiotics within 30 days prior to admission, were not discharged, or had not completed antibiotics by end of study period were excluded. Results: Data were obtained from a total of 140 patients (70 in each group). Of these, 25 (35.7%) in the RVP group and 28 (40.0%) in the rapid RP group had a positive result. The median LOS was 4.5 days (IQR, 3-9 days) in the RVP group and 5 days (IQR, 3-9 days) in the rapid RP group ( P = .78). The median duration of antibiotic use was 4 days (IQR, 2-7 days) in the RVP group and 5 days (IQR, 1-7 days) in the rapid RP group ( P = .8). Conclusion: Despite faster turnaround time, there was no significant difference in duration of antibiotic use, or LOS between the RVP and rapid RP groups.

Detection of male genital infection with Chlamydia trachom atis and Neisseria gonorrhoeae using an automated multiplex PCR system (Cobas AmplicorTM)

1998 ◽  
Vol 9 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Stephen P Higgins ◽  
Paul E Klapper ◽  
J Keith Struthers ◽  
Andrew S Bailey ◽  
Alison P Gough ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Dot Blot ◽  
Chain Reaction ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Primary Care Settings ◽  
Highly Sensitive ◽  
Significant Difference ◽  
Polymerase Chain ◽  
Male Genital

Summary: We evaluated Cobas AmplicorTM, a highly automated polymerase chain reaction (PCR) system, to test first-void urine (FVU) and urethral swab specimens for Chlamydia trachomatis and Neisseria gonorrhoeae in men attending a sexually transmitted infection (STI) clinic. Results were compared against an inhouse radioimmune dot blot (DB) test for C. trachomatis and selective culture for N. gonorrhoeae . Three hundred and ninety sets of specimens were obtained from 378 consecutive new and returned-new patients. Gonorrhoea prevalence was 9.49%, with no significant difference in sensitivity or specificity between culture and PCR. Chlamydia prevalence was 15.4%, with sensitivities of: DB 55%, PCR of FVU 86.7%, urethral swab PCR 90%. The specificity of PCR on FVU and urethral swabs was 100%. We have shown that Cobas AmplicorTM PCR is highly sensitive and specific in the diagnosis of chlamydia and gonorrhoea in men attending an STI clinic. Further economic and scientific studies are needed to determine the costeffectiveness of this technique for screening in primary care settings.

scholarly journals Virus-transformed pre-B cells show ordered activation but not inactivation of immunoglobulin gene rearrangement and transcription.

1991 ◽  
Vol 173 (3) ◽  
pp. 711-720 ◽  
Author(s):  
M S Schlissel ◽  
L M Corcoran ◽  
D Baltimore
Keyword(s):  
B Cells ◽  
Cell Lines ◽  
Gene Rearrangement ◽  
Gene Segment ◽  
Allelic Exclusion ◽  
Immunoglobulin Gene ◽  
Chain Reaction ◽  
Highly Sensitive ◽  
Sensitive Polymerase Chain Reaction ◽  
Polymerase Chain

Virus-transformed pre-B cells undergo ordered immunoglobulin (Ig) gene rearrangements during culture. We devised a series of highly sensitive polymerase chain reaction assays for Ig gene rearrangement and unrearranged Ig gene segment transcription to study both the possible relationship between these processes in cultured pre-B cells and the role played by heavy (H) chain (mu) protein in regulating gene rearrangement. Our analysis of pre-B cell cultures representing various stages of maturity revealed that transcription of each germline Ig locus precedes or is coincident with its rearrangement. Cell lines containing one functional rearranged H chain allele, however, continue to transcribe and to rearrange the allelic, unrearranged H chain locus. These cell lines appear to initiate but not terminate rearrangement events and therefore provide information about the requirements for activating rearrangement but not about allelic exclusion mechanisms.

The impact of changing reflexive to clinician-ordered Clostridioides difficile polymerase chain reaction (PCR) testing for indeterminate cases: Cost savings without associated adverse events

2020 ◽  
Vol 41 (6) ◽  
pp. 684-690
Author(s):  
Eva L. Sullivan ◽  
Rohit Majumdar ◽  
Courtney Ortiz ◽  
Patricia K. Riggs ◽  
Nancy F. Crum-Cianflone
Keyword(s):  
Polymerase Chain Reaction ◽  
Adverse Events ◽  
Cost Savings ◽  
Primary Study ◽  
Chain Reaction ◽  
Clostridioides Difficile ◽  
Before And After ◽  
Polymerase Chain ◽  
The Impact ◽  
Pcr Test

AbstractObjective:To evaluate changing Clostridioides difficile infection (CDI) testing among inpatients with indeterminate enzyme immunoassay (EIA) results (antigen+/toxin−) from reflexive polymerase chain reaction (PCR) testing to clinician-ordered PCR testing.Design:Multicenter, before-and-after, quasi-experimental study.Setting:Four large urban tertiary-care hospitals.Methods:We evaluated two 6-month periods before and after an intervention. The primary study outcome was the change in the number of CDI diagnoses between periods. Secondary outcomes included the number of PCR tests performed, adverse events, and healthcare cost savings.Results:In total, 500 EIA-indeterminate C. difficile test results were evaluated: 281 before the intervention and 219 thereafter. CDI was diagnosed by PCR among EIA-indeterminate cases in 182 in the preintervention period versus 94 patients in the postintervention period (48% reduction; P < .01). PCR testing was performed in 99.6% of indeterminate cases (280 of 281; 1 not performed due to an inhibitor) in the preintervention period versus 66% (144 of 219) in the postintervention period (34% reduction; P < .01). We observed no differences between study periods in 30-day all-cause (P = .96), GI-related (P = .93), or C. difficile (P = .47) readmissions, nor in 30-day C. difficile infections (P > .99). No patient without a PCR test in the postintervention period and not treated was later diagnosed with CDI. Each reflexive PCR test not performed led to a cost savings of $4,498 per patient.Conclusions:Applying diagnostic stewardship to C. difficile PCR testing in the inpatient setting led to significant reductions in both testing and cases. Changing the C. difficile PCR testing algorithm for EIA-indeterminate cases from reflexive to clinician-required ordering resulted in valuable cost savings without associated adverse events.

scholarly journals Airborne Severe Acute Respiratory Syndrome Coronavirus Concentrations in a Negative-Pressure Isolation Room

2006 ◽  
Vol 27 (5) ◽  
pp. 523-525 ◽  
Author(s):  
Ying-Huang Tsai ◽  
Gwo-Hwa Wan ◽  
Yao-Kuang Wu ◽  
Kuo-Chien Tsao
Keyword(s):  
Polymerase Chain Reaction ◽  
Severe Acute Respiratory Syndrome ◽  
Ventilatory Support ◽  
Polymerase Chain Reaction Method ◽  
Sars Coronavirus ◽  
Chain Reaction ◽  
Mechanical Ventilatory Support ◽  
Before And After ◽  
Sensitive Polymerase Chain Reaction ◽  
Polymerase Chain

This study used a sensitive polymerase chain reaction method coupled with filter sampling to detect the presence of airborne severe acute respiratory syndrome (SARS) coronavirus in an isolation patient room with a patient with severe acute respiratory syndrome receiving mechanical ventilatory support. Polymerase chain reaction results were negative for SARS coronavirus in room air both before and after patient extubation.

Highly sensitive polymerase chain reaction-free quantum dot-based quantification of forensic genomic DNA

2012 ◽  
Vol 721 ◽  
pp. 85-91 ◽  
Author(s):  
Yu Kyung Tak ◽  
Won Young Kim ◽  
Min Jung Kim ◽  
Eunyoung Han ◽  
Myun Soo Han ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Quantum Dot ◽  
Genomic Dna ◽  
Chain Reaction ◽  
Highly Sensitive ◽  
Sensitive Polymerase Chain Reaction ◽  
Polymerase Chain

scholarly journals Enzyme Immunoassay for C. difficile Toxin Reduces Lab ID Events but Fails to Detect Clinically Significant C. difficile Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S398-S398
Author(s):  
Jessica P Ridgway ◽  
Cynthia Murillo ◽  
Rachel Marrs ◽  
Sylvia Garcia-Houchins ◽  
Clinitka Harper ◽  
...  
Keyword(s):  
Enzyme Immunoassay ◽  
Chart Review ◽  
Nucleic Acid Amplification ◽  
Clinical Tests ◽  
Chain Reaction ◽  
Two Stage ◽  
Significant Difference ◽  
Polymerase Chain ◽  
Clinically Significant ◽  
Testing Algorithm

Abstract Background The National Health Safety Network (NHSN) requires reporting of Lab ID events for C. difficile infection (CDI) including all positive clinical tests after day three of hospitalization. Nucleic acid amplification tests (NAAT) that detect genes for toxins A and/or B may be overly sensitive, in some cases detecting C. difficile colonization. Some have advocated for two-stage testing, with positive NAAT tests followed by confirmatory enzyme immunoassay (EIA) to detect the presence of toxin and minimize the downside of false positives (i.e. additional NHSN reports or overuse of antibiotics). We aimed to better understand clinical characteristics of patients with positive NAAT and/or EIA tests. Methods Our hospital uses Xpert C. difficile assay (Cepheid), a NAAT method utilizing polymerase chain reaction (PCR), to diagnose CDI on unformed stool only. As part of a 6 month quality initiative, we pilot tested the C.DIFF QUIK CHEK COMPLETE® test (Alere), an EIA that tests for C. difficileantigen (Ag) and toxin, on all specimens that tested positive by NAAT. We abstracted clinical data from the medical record for a subset of patients who underwent EIA testing. Results Over 6 months, 294 patients had a positive test by NAAT. Of these, 258 (87.8%) underwent EIA testing. 67 (26.0%) were Ag+/toxin+, 173 (67.1%) were Ag+/toxin-, and 18 (6.8%) were Ag-/toxin-. Mortality rates were as follows: Ag+/toxin+, 17.9% (12/67); Ag+/toxin-, 13.9% (24/173); Ag-/toxin-, 27.8% (5/18), P = 0.27. Among the EIA toxin negative patients who underwent chart review, 81% had 3 or more loose stools within 24 hours, 62% had abdominal pain, nausea, or vomiting, and 27% had a WBC &gt; 15. Conclusion The majority of patients testing positive for CDI by NAAT had a negative EIA test for toxin. There was no significant difference in mortality between EIA toxin positive and negative. Those with negative EIA toxin tests often had clinically significant symptoms of CDI. A two-stage CDI testing algorithm with NAAT followed by EIA for toxin may exclude patients with clinically significant CDI but would have resulted in a 75% reduction in reported NHSN LabID events. Disclosures All authors: No reported disclosures.

scholarly journals RESULTS OF THE USE OF SOFOSBUVIR IN COMBINATION WITH LEDIPASVIR OR DACLATASVIR FOR CHRONIC HEPATITIS C TREATMENT IN THE REPUBLIC OF BELARUS

2018 ◽  
Vol 10 (3) ◽  
pp. 77-83
Author(s):  
S. V. Zhavoronok ◽  
V. R. Gutmane ◽  
T. M. Baryash ◽  
O. V. Soldatenko ◽  
T. V. Znovets ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Repeated Treatment ◽  
Chain Reaction ◽  
Highly Sensitive ◽  
Sensitive Polymerase Chain Reaction ◽  
Polymerase Chain

To evaluate the efficacy of therapy with sofosbuvir in combination with ledipasvir or daclatasvir, the results of treatment of 299 patients with chronic hepatitis C, including 128 non-responders to combined interferon plus ribavirin therapy, who have prognostically unfavorable single nucleotide polymorphisms 39743165T> G (rs8099917) and 39738787C> T (rs12979860) of interleukin-28B gene, were analyzed. 57 people had liver cirrhosis. 80,9% (242) had genotype 1 of hepatitis C virus, 5% (15) – genotype 2, 13,7% (41) – genotype 3, and 0,4% (1) – genotype 4.All 299 patients, who adhered to the recommendations of the European Association for the Study of the Liver 2016 and the American Association for the Study of the Liver Disease 2017, achieved a sustained virologic response 12 weeks after the end of therapy. The clinical case of treatment failure, associated with the lack of confirmation of the elimination of hepatitis C virus by means of highly sensitive polymerase chain reaction methods and with the later identified amino acid substitution in position Y93H of NS5A (resistance to NS5A inhibitors), is shown.It is necessary to carry out monitoring of effectiveness of therapy only by means of highly sensitive polymerase chain reaction (from 10 ME/ml). If the virus elimination delays in patients with advanced stages of liver fibrosis it is needed to use the prolonged schemes of treatment. Repeated treatment of patients with existence of a mutation of Y93H requires the use of new NS5A inhibitors or combined drugs.

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