scholarly journals Searching for a Potential Algorithm for Clostridium difficile Testing at a Tertiary Care Hospital: Does Toxin Enzyme Immunoassay Testing Help?

2018 ◽  
Vol 56 (7) ◽  
pp. e00415-18
Author(s):  
Angela M. Theiss ◽  
Agnes Balla ◽  
Angie Ross ◽  
Denise Francis ◽  
Christina Wojewoda
Keyword(s):  
Clostridium Difficile ◽  
Clinical Management ◽  
Tertiary Care ◽  
Laboratory Data ◽  
The United States ◽  
Care Hospital ◽  
Content Type ◽  
Molecular Tests ◽  
Stool Samples ◽  
Testing Algorithm

ABSTRACT Clostridium difficile is a major contributor to morbidity and mortality in the United States. Methods for identifying the organism in stool include molecular platforms, enzyme immunoassays (EIAs) for toxin, and culture. Controversy persists over whether molecular tests are too sensitive at identifying C. difficile, and there are questions about how additional laboratory information could inform clinical management and reduce over treatment. The aim of this study was to assess whether clinical factors are related to the toxin status of patients and whether information about toxin status could potentially inform clinical management of patients. A total of 201 PCR-positive C. difficile stool samples from adult patients at our institution underwent EIA toxin testing. Clinical and laboratory data were collected, and the percentage of PCR-positive/EIA-positive (PCR+/EIA+) patients and PCR+ and EIA-negative (PCR+/EIA−) patients was calculated. Of the 201 samples, 47% were EIA positive and 53% were EIA negative. Although PCR+/EIA+ patients were more likely to have had a prior C. difficile infection (P = 0.015), there was no statistical difference between the additional data collected that correlated with a positive EIA result. We were unable to show that patients with an EIA+ result had worse clinical parameters than those with EIA− results and concluded that establishing a testing algorithm that included both PCR and EIA testing would not change the clinical management of patients at our hospital.

scholarly journals Effectiveness of a Two-Step Testing Algorithm for Reliable and Cost-Effective Detection of Clostridium difficile Infection in a Tertiary Care Hospital in Saudi Arabia

2019 ◽  
Vol 7 (1) ◽  
pp. 6
Author(s):  
Mohammed Qutub ◽  
Prasanth Govindan ◽  
Anupama Vattappillil
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Tertiary Care ◽  
Care Hospital ◽  
Predictive Values ◽  
Stool Samples ◽  
Step Algorithm ◽  
Testing Algorithm ◽  
Sensitivity Specificity ◽  
Pcr Test

The aim of this study was to evaluate the effectiveness of a two-step algorithm for the detection of Clostridium difficile infection. Setting and Design: A two-step testing algorithm was evaluated for testing stool samples from patients suspected of Clostridium difficile infection (CDI). A total of 103 stool specimens were tested using the C. diff Quik Chek Complete enzyme immunoassay (EIA) test and the Xpert C. difficile PCR test. A two-step algorithm was implemented, and data from 3518 patient samples tested during a two-year period after implementation were analyzed to evaluate the effectiveness. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the Quik Chek Complete EIA test were calculated using the Xpert C. difficile PCR test as a reference method. The sensitivity, specificity, PPV, and NPV of the Quik Chek Complete EIA test for C. difficile toxin were 46.7%, 100%, 100%, and 91%, respectively. The two-step algorithm, which combined the Quik Chek Complete EIA with Xpert C. difficile PCR, improved the sensitivity and also provided rapid detection. When algorithm-based testing was performed daily, there was a 66% reduction in turnaround time compared to batch testing using a lengthy ELISA procedure. Postimplementation data analysis showed that almost 89% of the samples could be reported immediately by initial screening with Quik Chek Complete EIA. Only 11% of the samples gave discrepant results and required PCR confirmation. According to our results, the two-step algorithm is an effective tool for the rapid and reliable detection of toxigenic C. difficile from stool samples.

scholarly journals Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

2015 ◽  
Vol 59 (8) ◽  
pp. 4533-4543 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Sondra Seiler ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Content Acquisition ◽  
Stool Samples

ABSTRACTAsymptomatic colonization may contribute toClostridium difficiletransmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study ofC. difficilecolonization and risk factors forC. difficileacquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics,C. difficileinfection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured forC. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized withC. difficile(toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated withC. difficileacquisition (47% of patients who acquiredC. difficileversus 25% of patients who did not;P= 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss ofC. difficilecolonization (36% of patients who lostC. difficilecolonization versus 8% of patients colonized at both admission and discharge;P= 0.04), as was metronidazole (27% versus 3%;P= 0.03). Antibiotic use affects the epidemiology of asymptomaticC. difficilecolonization, including acquisition and loss, and it requires additional study.

scholarly journals Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

2018 ◽  
Vol 39 (11) ◽  
pp. 1330-1333 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
Candice Cass ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Population ◽  
Tertiary Care ◽  
Clinical Microbiology Laboratory ◽  
Care Hospital ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Stool Specimens ◽  
Clinically Significant ◽  
Culture Negative

AbstractObjectiveTo determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.DesignRetrospective cohort.SettingTertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital’s clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.InterventionsElectronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.ResultsA total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (−). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA− stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA− stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).ConclusionsMost patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA− patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

scholarly journals Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

2014 ◽  
Vol 58 (9) ◽  
pp. 5079-5083 ◽  
Author(s):  
Judith Maria Wenisch ◽  
Susanne Equiluz-Bruck ◽  
Marta Fudel ◽  
Ingun Reiter ◽  
Andrea Schmid ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Period 2 ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Mean

ABSTRACTClostridium difficileinfections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (± standard error of the mean [SEM]) of 1,038 ± 109 DDD per month (period 1) to 42 ± 10 DDD per month (period 2) (P= 0.0045). Total antibiotic use was not affected. The mean (±SEM) numbers of CDI cases in period 1 were 59 ± 3 per month and in period 2 were 32 ± 3 per month (46% reduction;P= 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.

scholarly journals Etiology of Infectious Diarrhea in Patients Tested for Clostridium difficile: If It Isn’t Clostridium difficile, What Is It?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S2-S2
Author(s):  
Jennie H Kwon ◽  
Tiffany Hink ◽  
Kimberly Reske ◽  
Erik R Dubberke ◽  
Carey-Ann D Burnham
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Agar Plate ◽  
Stool Culture ◽  
Blood Agar Plate ◽  
Care Hospital ◽  
E Coli ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Research Grant

Abstract Background The objective of the study was to assay for alternative infectious causes of diarrhea in patients with negative EIA tests for Clostridium difficile. Methods A hard-stop alert was implemented at a tertiary care hospital to limit repeat testing for C. difficile within 96 hours of an initial negative EIA. Stool samples from patients with a negative (–) repeat EIA test for C. difficile within 96 hours in the 3 months pre- and postintervention underwent further evaluation: C. difficile toxigenic culture, GeneXpert C. difficile PCR, Biofire Gastrointestinal (GI) Panel, and culture on a blood agar plate. Results Of the 84 C. difficile EIA stool specimens evaluated, 8% were toxigenic culture positive (+), 8% tested + for C. difficile via the Biofire GI panel, and 5 (7%) + with the GenXpert C. difficile PCR (Table 1). Three of these patients were diagnosed with CDI within 30 days of a + test. Five patients were + for Norovirus via Biofire GI panel; none were tested for or diagnosed with Norovirus. Two patients were + for Enteropathogenic E. coli and one for Enteroaggregative E. coli via Biofire GI panel; none were tested for or diagnosed with E. coli infection. One patient was positive for Salmonella and Salmonella was isolated by stool culture. Conclusion Patients tested for C. difficile may have alternate causes of diarrhea. When evaluating hospitalized patients with diarrhea, C. difficile, along with alternate causes of diarrhea can be considered. Disclosures E. R. Dubberke, Merck: Consultant, Consulting fee; Biofire: one time talk, Speaker honorarium;; Alere: one-time talk, Speaker honorarium; Sanofi pasteur: Grant Investigator, Grant recipient; Pfizer: Consultant, Consulting fee; Rebiotix: Investigator, Research support; Rebiotix: Consultant, Consulting fee; valneva: Consultant, Consulting fee; C. A. D. Burnham, bioMerieux: Grant Investigator, Research grant; ThermoFisher: Consultant, Salary; Cepheid: Grant Investigator, Research grant

scholarly journals Vancomycin Use for Pediatric Clostridium difficile Infection Is Increasing and Associated with Specific Patient Characteristics

2013 ◽  
Vol 57 (9) ◽  
pp. 4307-4313 ◽  
Author(s):  
Hayden T. Schwenk ◽  
Dionne A. Graham ◽  
Tanvi S. Sharma ◽  
Thomas J. Sandora
Keyword(s):  
Clostridium Difficile ◽  
Severe Disease ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
The United States ◽  
Initial Therapy ◽  
Children's Hospitals ◽  
Specific Patient ◽  
Content Type ◽  
Children’S Hospitals

ABSTRACTIn adults withClostridium difficileinfection (CDI), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with CDI are unknown. We sought to describe trends in and predictors of vancomycin use for the treatment of children with CDI admitted to tertiary-care children's hospitals in the United States. We used a database of freestanding children's hospitals to identify patients 1 to 18 years old with CDI between January 2006 and June 2011. The first hospitalization with a diagnosis of CDI for each patient was identified, and CDI-directed therapy was assessed. Generalized estimating equations were used to identify predictors of vancomycin receipt, controlling for clustering within hospitals. Vancomycin use has increased significantly (P= 0.005), with substantial variability between hospitals (0 to 16%). In multivariate analyses, vancomycin use was more common in children age 7 to 13 years old (versus children 1 to 2 years old: adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI] = 1.13 to 2.18), 14 to 18 years old (AOR = 1.40; 95% CI = 1.11 to 1.76), in an ICU (AOR = 1.37; 95% CI = 1.05 to 1.80), or with chronic gastrointestinal conditions (AOR = 2.01; 95% CI = 1.44 to 2.81). Vancomycin use was less common in black (AOR = 0.53; 95% CI = 0.39 to 0.73) and Hispanic (AOR = 0.63; 95% CI = 0.47 to 0.84) patients and in children with malignancies (AOR = 0.57; 95% CI = 0.36 to 0.89). Despite a lack of empirical evidence to suggest superiority, vancomycin use for pediatric CDI is increasing. Furthermore, there is substantial variability in vancomycin use between hospitals. Further studies are needed to explore potential racial and ethnic differences in CDI management and to investigate clinicians' rationale for using vancomycin for initial therapy in selected populations.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Atiporn Boonyai ◽  
Anchalee Thongput ◽  
Thidarat Sisaeng ◽  
Parisut Phumchan ◽  
Navin Horthongkham ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Organ Transplant ◽  
Hospital Setting ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Serum Samples ◽  
Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

scholarly journals Inflammasome Activation Contributes to Interleukin-23 Production in Response to Clostridium difficile

mBio ◽  
2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Carrie A. Cowardin ◽  
Sarah A. Kuehne ◽  
Erica L. Buonomo ◽  
Chelsea S. Marie ◽  
Nigel P. Minton ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Disease Severity ◽  
Tissue Damage ◽  
The United States ◽  
Host Cells ◽  
Inflammasome Activation ◽  
Content Type ◽  
Danger Signals ◽  
Interleukin 23 ◽  
Molecular Patterns

ABSTRACT  Clostridium difficileis the most common hospital-acquired pathogen, causing antibiotic-associated diarrhea in over 250,000 patients annually in the United States. Disease is primarily mediated by toxins A and B, which induce potent proinflammatory signaling in host cells and can activate an ASC-containing inflammasome. Recent findings suggest that the intensity of the host response to infection correlates with disease severity. Our lab has identified the proinflammatory cytokine interleukin-23 (IL-23) as a pathogenic mediator during C. difficile infection (CDI). The mechanisms by which C. difficile induces IL-23, however, are not well understood, and the role of toxins A and B in this process is unclear. Here, we show that toxins A and B alone are not sufficient for IL-23 production but synergistically increase the amount of IL-23 produced in response to MyD88-dependent danger signals, including pathogen-associated molecular patterns (PAMPs) and host-derived damage associated molecular patterns (DAMPs). Danger signals also enhanced the secretion of IL-1β in response to toxins A and B, and subsequent IL-1 receptor signaling accounted for the majority of the increase in IL-23 that occurred in the presence of the toxins. Inhibition of inflammasome activation in the presence of extracellular K+likewise decreased IL-23 production. Finally, we found that IL-1β was increased in the serum of patients with CDI, suggesting that this systemic response could influence downstream production of pathogenic IL-23. Identification of the synergy of danger signals with toxins A and B via inflammasome signaling represents a novel finding in the mechanistic understanding of C. difficile-induced inflammation.IMPORTANCEClostridium difficileis among the leading causes of death due to health care-associated infection, and factors determining disease severity are not well understood. C. difficile secretes toxins A and B, which cause inflammation and tissue damage, and recent findings suggest that some of this tissue damage may be due to an inappropriate host immune response. We have found that toxins A and B, in combination with both bacterium- and host-derived danger signals, can induce expression of the proinflammatory cytokines IL-1β and IL-23. Our results demonstrate that IL-1β signaling enhances IL-23 production and could lead to increased pathogenic inflammation during CDI.

Sign in / Sign up

Export Citation Format

Share Document