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Lee HW, Yu HJ, Kim H, Yun SA, Suh E, Kang M, Kim TY, Huh HJ, Lee NY. Comparative evaluation of the STANDARD M10 and Xpert C. difficile assays for detection of toxigenic Clostridioides difficile in stool specimens. J Clin Microbiol 2024; 62:e0052424. [PMID: 38934589 PMCID: PMC11250526 DOI: 10.1128/jcm.00524-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
This study compared the performance of two commercial molecular assays, the STANDARD M10 Clostridioides difficile assay (M10) and the Xpert C. difficile assay (Xpert), for detecting toxigenic C. difficile in stool specimens. A total of 487 consecutive stool specimens submitted for routine C. difficile testing between June and November 2023 were included. Following routine testing using C. DIFF QUIK CHEK COMPLETE (QCC), M10 and Xpert were tested in parallel, alongside toxigenic culture (reference standard). Additionally, two-step algorithms, using QCC on the first step and either M10 or Xpert on the second step, were assessed. Both M10 and Xpert demonstrated a sensitivity and negative predictive value (NPV) of 100%. M10 exhibited significantly higher specificity and positive predictive value (PPV; 91.9% and 64.2%, respectively) than Xpert (90.3% and 59.8%, respectively). Both two-step algorithms showed a sensitivity and NPV of 98.4% and 99.8%, respectively. The specificity and PPV of the two-step algorithm using M10 (95.2% and 75.0%, respectively) were slightly higher than those of the one using Xpert (94.8% and 73.2%, respectively), without statistical significance. Receiver operating characteristic curve analysis, assessing the predictive ability of cycle threshold (Ct) values for the detection of free toxin, exhibited an area under the curve of 0.825 for M10 and 0.843 for Xpert. This indicates the utility of Ct values as predictors for the detection of free toxin in both assays. In conclusion, M10 proves to be an effective diagnostic tool with performance comparable to Xpert, whether utilized independently or as part of a two-step algorithm.
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Affiliation(s)
- Hyun-Woo Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hui-Jin Yu
- Department of Laboratory Medicine, Seoul Medical Center, Seoul, South Korea
| | - Heejung Kim
- Department of Laboratory Medicine, Seoul Medical Center, Seoul, South Korea
| | - Sun Ae Yun
- Center for Clinical Medicine, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Eunsang Suh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Minhee Kang
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Seoul, South Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Guh AY, Fridkin S, Goodenough D, Winston LG, Johnston H, Basiliere E, Olson D, Wilson CD, Watkins JJ, Korhonen L, Gerding DN. Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test. Infect Control Hosp Epidemiol 2024; 45:590-598. [PMID: 38268440 PMCID: PMC11027077 DOI: 10.1017/ice.2023.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (-). We compared NAAT+/toxin- and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin- patients. DESIGN Retrospective observational study. SETTING The study was conducted across 36 laboratories at 5 Emerging Infections Program sites. PATIENTS We defined a CDI case as a positive test detected by this 2-step algorithm during 2018-2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks. METHODS We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin- and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin- cases. RESULTS Of 1,801 cases, 1,252 were NAAT+/toxin-, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin- cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin- status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55-0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87-1.28). Among NAAT+/toxin- cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28-2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40-2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23-4.68) were predictors of CDI treatment. CONCLUSION Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin- cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin- cases.
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Affiliation(s)
- Alice Y. Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott Fridkin
- Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Dana Goodenough
- Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Decatur, Georgia
- Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
| | - Lisa G. Winston
- University of California, San Francisco, School of Medicine, San Francisco, California
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Danyel Olson
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Lauren Korhonen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dale N. Gerding
- Edward Hines, Jr., Veterans’ Affairs Hospital, Hines, Illinois
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Cho DH, Kim SH, Jeon CH, Kim HT, Park KJ, Kim J, Kwak J, Kwan BS, Kong S, Lee JW, Kim KM, Wi YM. Clinical outcomes and treatment necessity in patients with toxin-negative Clostridioides difficile stool samples. Ann Clin Microbiol Antimicrob 2024; 23:35. [PMID: 38664689 PMCID: PMC11046793 DOI: 10.1186/s12941-024-00696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE The clinical significance of negative toxin enzyme immunoassays (EIA) for Clostridioides difficile infections (CDIs) is unclear. Our study aimed to investigate the significance of toxin EIA-negative in the diagnosis and prognosis of CDI. METHODS All stool specimens submitted for C. difficile toxin EIA testing were cultured to isolate C. difficile. In-house PCR for tcdA, tcdB, cdtA, and cdtB genes were performed using C. difficile isolates. Stool specimens were tested with C. difficile toxins A and B using EIA kit (RIDASCREEN Clostridium difficile toxin A/B, R-Biopharm AG, Darmstadt, Germany). Characteristics and subsequent CDI episodes of toxin EIA-negative and -positive patients were compared. RESULTS Among 190 C. difficile PCR-positive patients, 83 (43.7%) were toxin EIA-negative. Multivariate analysis revealed independent associations toxin EIA-negative results and shorter hospital stays (OR = 0.98, 95% CI 0.96-0.99, p = 0.013) and less high-risk antibiotic exposure in the preceding month (OR = 0.38, 95% CI 0.16-0.94, p = 0.035). Toxin EIA-negative patients displayed a significantly lower white blood cell count rate (11.0 vs. 35.4%, p < 0.001). Among the 54 patients who were toxin EIA-negative and did not receive CDI treatment, three (5.6%) were diagnosed with CDI after 7-21 days without complication. CONCLUSION Our study demonstrates that toxin EIA-negative patients had milder laboratory findings and no complications, despite not receiving treatment. Prolonged hospitalisation and exposure to high-risk antibiotics could potentially serve as markers for the development of toxin EIA-positive CDI.
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Affiliation(s)
- Dae Hyeon Cho
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Si-Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon-si, 51353, Gyeongsangnam-do, Republic of Korea
| | - Cheon Hoo Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon-si, 51353, Gyeongsangnam-do, Republic of Korea
| | - Hyoung Tae Kim
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kyoung-Jin Park
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Junyoung Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jiyeong Kwak
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Byung Soo Kwan
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sungmin Kong
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jung Won Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kwang Min Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon-si, 51353, Gyeongsangnam-do, Republic of Korea.
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Knoth C, Humphries R, Johnson JK, Patel A, Lima A, Silbert S, Vinjé J. Multicenter evaluation of BioCode GPP for syndromic molecular detection of gastrointestinal pathogens from stool specimens. J Clin Microbiol 2024; 62:e0154523. [PMID: 38329337 PMCID: PMC10935640 DOI: 10.1128/jcm.01545-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality worldwide across all age groups that disproportionally affects young children in low- and middle-income countries and immunocompromised patients in high-income countries. Regional outbreaks of AGE are typically detected by traditional microbiological detection methods that target limited organisms and are associated with low sensitivity and lengthy time-to-results. Combined, these may result in repeat testing, imprecise or delayed treatment, and delayed recognition of outbreaks. We conducted a multi-site prospective study comparing the BioCode Gastrointestinal Pathogen Panel (BioCode GPP) for the detection of 17 common bacterial, viral, and protozoan causes of gastroenteritis with reference methods, including stool culture, enzyme immunoassays, pathogen-specific PCR assays, and sequencing. One thousand five hundred fifty-eight residual, de-identified stool samples (unpreserved stool and stool in Cary-Blair transport medium) were enrolled and tested for 11 bacterial, 3 viral, and 3 protozoan pathogens. BioCode GPP and reference methods were positive for 392 (25.2%) and 283 (18.2%) samples, respectively (P < 0.0001). In this study, the BioCode GPP and reference methods detected 69 and 65 specimens positive for Clostridioides difficile, 51 and 48 for enteroaggregative Escherichia coli, 33 and 27 for enterotoxigenic E. coli, 50 and 47 for norovirus GI/GII, and 30 and 22 for rotavirus A, respectively. The BioCode GPP showed good positive and negative agreements for each pathogen ranging from 89.5% to 100%, with overall sensitivity and specificity of 96.1% and 99.7%, post adjudication. The BioCode GPP detected >1 pathogens in 49 samples, representing 12.5% of the total 392 positive specimens. IMPORTANCE This study highlights performance of a novel technology for timely and accurate detection and differentiation of 17 common bacterial, viral, and protozoan causes of gastroenteritis. Utilizing molecular tests such as the BioCode Gastrointestinal Pathogen Panel may improve the detection of gastrointestinal pathogens and provide actionable results, particularly for patient populations at most risk.
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Affiliation(s)
| | - Romney Humphries
- University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - J. Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anami Patel
- Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | | | | | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Prosty C, Hanula R, Katergi K, Longtin Y, McDonald EG, Lee TC. Clinical Outcomes and Management of NAAT-Positive/Toxin-Negative Clostridioides difficile Infection: A Systematic Review and Meta-Analysis. Clin Infect Dis 2024; 78:430-438. [PMID: 37648251 DOI: 10.1093/cid/ciad523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Standalone nucleic acid amplification tests (NAATs) are frequently used to diagnose Clostridioides difficile infections (CDI), although they may be unable to distinguish colonization from disease. A 2-stage algorithm pairing NAATs with toxin immunoassays (Toxin) may improve specificity. We evaluated clinical outcomes of patients who were NAAT+/Toxin+ versus NAAT+/Toxin- and treated versus untreated NAAT+/Toxin- cases through systematic review and meta-analysis. METHODS We searched EMBASE and MEDLINE from inception to April 1, 2023 for articles comparing CDI outcomes among symptomatic patients tested by NAAT and Toxin tests. The risk differences (RD) of all-cause mortality and CDI recurrence were computed by random effects meta-analysis between patients who were NAAT+/Toxin+ and NAAT+/Toxin-, as well as between patients who were NAAT+/Toxin- and treated or untreated. RESULTS Twenty-six observational studies comprising 12 737 patients were included. The 30-day all-cause mortality was not significantly different between those who were NAAT+/Toxin+ (8.4%) and NAAT+/Toxin- (6.7%) (RD = 0.41%, 95% confidence interval [CI] = -.67, 1.49). Recurrence at 60 days was significantly higher among patients who were NAAT+/Toxin+ (19.8%) versus NAAT+/Toxin- (11.0%) (RD = 7.65%, 95% CI = 4.60, 10.71). Among treated compared to untreated NAAT+/Toxin- cases, the all-cause 30-day mortalities were 5.0% and 12.7%, respectively (RD = -7.45%, 95% CI = -12.29, -2.60), but 60-day recurrence was not significantly different (11.6% vs 7.0%, respectively; RD = 5.25%, 95% CI -1.71, 12.22). CONCLUSIONS Treatment of patients who were NAAT+/Toxin- was associated with reduced all-cause mortality but not recurrence. Although subject to the inherent limitations of observational studies, these results suggest that some patients who are NAAT+/Toxin- may benefit from treatment.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Ryan Hanula
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Khaled Katergi
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Yves Longtin
- Division of Infectious Diseases, Department of Medicine, Jewish General Hospital Sir Mortimer B. Davis, Montréal, QC, Canada
| | - Emily G McDonald
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Todd C Lee
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, QC, Montréal, Canada
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Hand J, Imlay H. Antimicrobial Stewardship in Immunocompromised Patients: Current State and Future Opportunities. Infect Dis Clin North Am 2023; 37:823-851. [PMID: 37741735 DOI: 10.1016/j.idc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Immunocompromised (IC) patients are high risk for complications due to a high rate of antibiotic exposure. Antimicrobial stewardship interventions targeted to IC patients can be challenging due to limited data in this population and a high risk of severe infection-related outcomes. Here, the authors review immunocompromised antimicrobial stewardship barriers, metrics, and opportunities for antimicrobial use and testing optimization. Last, the authors highlight future steps in the field.
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Affiliation(s)
- Jonathan Hand
- Ochsner Health, New Orleans, LA, USA; University of Queensland School of Medicine, Ochsner Clinical School
| | - Hannah Imlay
- University of Utah Department of Internal Medicine, Salt Lake City, UT, USA.
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Hecker MT, Son AH, Zuccaro P, Conti J, Donskey CJ. Real-world evaluation of a two-step testing algorithm for Clostridioides difficile infection. Infect Control Hosp Epidemiol 2023; 44:1494-1496. [PMID: 36750229 DOI: 10.1017/ice.2022.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
During the 4 years after implementation of the 2-step Clostridioides difficile infection (CDI) testing algorithm, 70% to 78% of patients with suspected CDI and a positive nucleic acid amplification test but a negative toxin test (NAAT+/TOX-) received CDI treatment. Overall, 73% of NAAT+/TOX- patients were classified as having probable or possible CDI.
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Affiliation(s)
- Michelle T Hecker
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrea H Son
- Department of Pharmacy, MetroHealth Medical Center, Cleveland, Ohio
| | - Patricia Zuccaro
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Jennifer Conti
- Department of Population Health, MetroHealth Medical Center, Cleveland, Ohio
| | - Curtis J Donskey
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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8
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Claeys KC, Johnson MD. Leveraging diagnostic stewardship within antimicrobial stewardship programmes. Drugs Context 2023; 12:dic-2022-9-5. [PMID: 36843619 PMCID: PMC9949764 DOI: 10.7573/dic.2022-9-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
Novel diagnostic stewardship in infectious disease consists of interventions that modify ordering, processing, and reporting of diagnostic tests to provide the right test for the right patient, prompting the right action. The interventions work upstream and synergistically with traditional antimicrobial stewardship efforts. As diagnostic stewardship continues to gain public attention, it is critical that antimicrobial stewardship programmes not only learn how to effectively leverage diagnostic testing to improve antimicrobial use but also ensure that they are stakeholders and leaders in developing new diagnostic stewardship interventions within their institutions. This review will discuss the need for diagnostic and antimicrobial stewardship, the interplay of diagnostic and antimicrobial stewardship, evidence of benefit to antimicrobial stewardship programmes, and considerations for successfully engaging in diagnostic stewardship interventions. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation.
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Affiliation(s)
- Kimberly C Claeys
- University of Maryland School of Pharmacy, Department of Practice Science and Health Outcomes Research, Baltimore, MD, USA
| | - Melissa D Johnson
- Division of Infectious Diseases & International Health, Duke University School of Medicine, Durham, NC, USA,Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center Durham, NC, USA
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Optimizing the interpretation of Clostridioides difficile two-step diagnostic algorithm results through antimicrobial stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e201. [PMID: 36712476 PMCID: PMC9879867 DOI: 10.1017/ash.2022.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
Over a 4-year period, the antimicrobial stewardship team reviewed all positive (PCR+/Tox+) and indeterminate (PCR+/Tox-) cases with the most responsible physician for classification of patients as infection or colonization. Among 501 indeterminate samples, 213 (43%) were considered to be clinical infection, suggesting the need for ongoing clinical assessment of indeterminates.
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10
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Wen BJ, Te LG, Liu XX, Zhao JH. The value of fecal calprotectin in Clostridioides difficile infection: A systematic review. Front Physiol 2022; 13:881816. [PMID: 35991191 PMCID: PMC9382106 DOI: 10.3389/fphys.2022.881816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
As a marker of inflammation, calprotectin has potential application value in a variety of inflammatory diseases, such as arthritis and bacterial infections. Clostridioides difficile infection (CDI) is an infectious disease that causes intestinal damage and inflammation. This systematic review aims to determine whether fecal calprotectin has application value in CDI. Nine databases were searched from inception to 6 June 2022, and 17 studies were included. These studies were divided into four groups according to their content. Generally speaking, fecal calprotectin is not an ideal indicator for the diagnosis and prognosis prediction of CDI but may serve as a potential indicator for assessing disease severity and as a readily detectable marker for CDI screening. In addition, patients in need of treatment or with detectable toxins in stool may tend to have higher levels of fecal calprotectin. In summary, fecal calprotectin has some potential application value in CDI. However, further studies are needed to verify these findings and determine the reliability of calprotectin as a biomarker for CDI.
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Affiliation(s)
- Bao-Jiang Wen
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li-Ger Te
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Xuan Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jian-Hong Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, Hebei, China
- *Correspondence: Jian-Hong Zhao,
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