Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era

JAMA Internal Medicine
Christopher R PolageStuart H Cohen

Abstract

Clostridium difficile is a major cause of health care-associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision making and public health reporting. Molecular tests are increasingly used to diagnose C difficile infection (CDI), but many molecular test-positive patients lack toxins that historically defined disease, making it unclear if they need treatment. To determine the natural history and need for treatment of patients who are toxin immunoassay negative and polymerase chain reaction (PCR) positive (Tox-/PCR+) for CDI. Prospective observational cohort study at a single academic medical center among 1416 hospitalized adults tested for C difficile toxins 72 hours or longer after admission between December 1, 2010, and October 20, 2012. The analysis was conducted in stages with revisions from April 27, 2013, to January 13, 2015. Patients undergoing C difficile testing were grouped by US Food and Drug Administration-approved toxin and PCR tests as Tox+/PCR+, Tox-/PCR+, or Tox-/PCR-. Toxin results were reported clinically. Polymerase chain reaction results were not reported. The main study outcomes were duration of diarrhea during up to 14 days of treatment, rate of CDI-related comp...Continue Reading

Associated Clinical Trials

Citations

Feb 20, 2016·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Sirisha KundrapuCurtis J Donskey
Mar 2, 2016·Journal of Comparative Effectiveness Research·Christopher R PolageStuart H Cohen
Mar 17, 2016·Epidemiology and Infection·A S GastañaduyR E Bégué
Mar 18, 2016·Expert Review of Molecular Diagnostics·Yuliya Zboromyrska, Jordi Vila
Jun 23, 2016·The Journal of Pediatrics·Maribeth R NicholsonJames D Chappell
Jul 16, 2016·Open Forum Infectious Diseases·Natasha M ChidaMichael T Melia
Sep 4, 2016·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·K DaviesM H Wilcox
Oct 4, 2016·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·B KullinS J Reid
Sep 27, 2016·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Sean G KellyMaureen K Bolon
Jan 14, 2017·Journal of Oncology Practice·Michael H Woodworth, Colleen S Kraft
Feb 6, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Damian P C MawerMark H Wilcox
Feb 6, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Preeta K Kutty, L Clifford McDonald
Jun 23, 2016·Journal of Gastroenterology·Sarah Lynn MartzElaine Olga Petrof
Feb 23, 2017·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·Y PaitanA Adler
Feb 9, 2017·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Sonya A TrinhMichael P Angarone
Jun 3, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Roberto L PatronRobert Orenstein
Mar 14, 2018·Journal of Medical Microbiology·Natalia BlancoBetsy Foxman
Feb 21, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·L Clifford McDonaldMark H Wilcox
Feb 15, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Belinda OstrowskyUNKNOWN Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and the Society for Healthcare Epidemiology o
Mar 30, 2017·Journal of Travel Medicine·A Michal StevensUNKNOWN GeoSentinel Surveillance Network
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Jan 26, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Larry K KociolekEgon A Ozer
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Apr 17, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jessica S H MartinMark H Wilcox

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