Discordant Clostridioides difficile diagnostic assay and treatment practice: a cross-sectional study in a tertiary care hospital, Geneva, Switzerland. Issue 9 (13th September 2020)

• Record Type: Journal Article
• Authors: Lenggenhager, Lauriane; Zanella, Marie-Céline; Poncet, Antoine; Kaiser, Laurent; Schrenzel, Jacques
• Is Part Of: BMJ open. Volume 10:Issue 9(2020)
• Publication Date: 2020-09-13
• Subjects: diagnostic microbiology -- gastrointestinal infections -- microbiology; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-036342
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To determine the proportion of patients who received a treatment for Clostridioides difficile infection (CDI) among those presenting a discordant C. difficile diagnostic assay and to identify patient characteristics associated with the decision to treat CDI. Design: Cross-sectional study. Setting: Monocentric study in a tertiary care hospital, Geneva, Switzerland. Participants: Among 4562 adult patients tested for C. difficile between March 2017 and March 2019, 208 patients with discordant tests' results (positive nucleic acid amplification test (NAAT+)/negative enzyme immunoassay (EIA−)) were included. Main outcome measures: Treatment for CDI. Results: CDI treatment was administered in 147 (71%) cases. In multivariate analysis, an abdominal CT scan with signs of colitis (OR 14.7; 95% CI 1.96 to 110.8) was the only factor associated with CDI treatment. Conclusions: The proportion of NAAT+/EIA− patients who received treatment questions the contribution of the EIA for the detection of toxin A/B after NAAT to limit overtreatment. Additional studies are needed to investigate if other factors are associated with the decision to treat.