BACKGROUND: Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes. METHODS: Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change). RESULTS: Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01). CONCLUSIONS: The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.
BACKGROUND:Clostridium difficileinfection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes. METHODS: Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change). RESULTS: Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01). CONCLUSIONS: The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.
Authors: L Clifford McDonald; George E Killgore; Angela Thompson; Robert C Owens; Sophia V Kazakova; Susan P Sambol; Stuart Johnson; Dale N Gerding Journal: N Engl J Med Date: 2005-12-01 Impact factor: 91.245
Authors: S Johnson; S R Homann; K M Bettin; J N Quick; C R Clabots; L R Peterson; D N Gerding Journal: Ann Intern Med Date: 1992-08-15 Impact factor: 25.391
Authors: Erik R Dubberke; Zhuolin Han; Linda Bobo; Tiffany Hink; Brenda Lawrence; Susan Copper; Joan Hoppe-Bauer; Carey-Ann D Burnham; William Michael Dunne Journal: J Clin Microbiol Date: 2011-06-22 Impact factor: 5.948