C Bogaty1, S Lévesque2, C Garenc3, C Frenette4, D Bolduc5, L-A Galarneau6, C Lalancette2, V Loo4, C Tremblay7, M Trudeau2, J Vachon8, M Dionne9, J Villeneuve9, J Longtin10, Y Longtin1. 1. McGill University Faculty of Medicine, Montréal, QC, Canada. 2. Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada. 3. Institut National de Santé Publique du Québec, Quebec City, QC, Canada; Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada. 4. McGill University Faculty of Medicine, Montréal, QC, Canada; McGill University Health Centre, Montréal, QC, Canada. 5. Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Rimouski, Quebec (QC), Canada. 6. Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Quebec (QC), Canada. 7. Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada; Laval University Faculty of Medicine, Quebec City, QC, Canada. 8. Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Thetford Mines, Quebec (QC), Canada. 9. Institut National de Santé Publique du Québec, Quebec City, QC, Canada. 10. Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada; Laval University Faculty of Medicine, Quebec City, QC, Canada. Electronic address: yves.longtin@mcgill.ca.
Abstract
BACKGROUND: Several Clostridium difficile infection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates. METHODS: Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions. RESULTS: The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P < .001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P = .01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P < .05). CONCLUSIONS: Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.
BACKGROUND: Several Clostridium difficileinfection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates. METHODS: Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions. RESULTS: The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P < .001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P = .01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P < .05). CONCLUSIONS: Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.
Authors: Jason Zou; Victor Leung; Sylvie Champagne; Michelle Hinch; Anna Wong; Elisa Lloyd-Smith; Trong Tien Nguyen; Marc G Romney; Azra Sharma; Michael Payne; Christopher F Lowe Journal: Eur J Clin Microbiol Infect Dis Date: 2018-09-20 Impact factor: 3.267
Authors: Nieves Sopena; Jun Hao Wang-Wang; Irma Casas; Lourdes Mateu; Laia Castellà; María José García-Quesada; Sara Gutierrez; Josep M Llibre; M Luisa Pedro-Botet; Gema Fernandez-Rivas Journal: Microorganisms Date: 2022-05-23