Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea. (18th September 2018)

• Record Type: Journal Article
• Authors: Dubberke, Erik R.; Reske, Kimberly A.; Hink, Tiffany; Kwon, Jennie H.; Cass, Candice; Bongu, Jahnavi; Burnham, Carey-Ann D.; Henderson, Jeffrey P.
• Is Part Of: Infection control and hospital epidemiology. Volume 39:Number 11(2018)
• Page Start: 1330
• Page End: 1333
• Publication Date: 2018-09-18
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2018.225
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Objective: To 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. Design: Retrospective cohort. Setting: Tertiary-care hospital in St. Louis, Missouri. Patients: Patients 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. Interventions: Electronic 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. Results: A 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%). Conclusions: Most 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%.