4 years ago

Comparison of the clinical course of Clostridium difficile infection in GDH-positive, toxin-negative patients diagnosed by PCR to those with a positive toxin test

To evaluate the potential role of PCR-based assays in the overdiagnosis of Clostridium difficile infection (CDI) by using a validated diagnostic algorithm in daily clinical practice. Methods We performed a retrospective cohort study evaluating all C. difficile-positive stool samples identified at our institution during a 12-month period, to compare outcomes and recurrence rate between patients with a positive enzyme-immunoassay (EIA) for both glutamate dehydrogenase (GDH) and toxin A/B (“toxin-positive group”), with those with GDH-positive, toxin-negative samples in which the diagnosis was made by a positive PCR-based assay (“toxin-/PCR+ group”). Medical records were reviewed by two independent investigators blinded to the mode of diagnosis. Results We analyzed 231 first CDI episodes (106 [45.8 %] in the “toxin-positive group” and 125 [54.1%] in the “toxin-/PCR+ group”). Both groups had similar baseline characteristics. Patients in the “toxin-positive group” presented more frequently with a severe/severe complicated form than those in the “toxin-/PCR+ group” (36 [33.9%] vs. 24 [19.2%]; P-value=0.011) and had more recurrences (27 [25.5%] vs. 9 [7.2%]; P-value<0.001). Diagnosis of CDI based on a GDH/toxin-positive EIA independently predicted severe/severe-complicated course (adjusted odds ratio [aOR]: 2.11; 95% confidence interval [95% CI]: 1.06-4.22; P-value=0.033) and recurrence (aOR: 3.79; 95% CI: 1.65-8.69; P-value=0.002). There were no differences in all-cause (12.3% vs. 12.0%; P-value=0.95) or CDI-attributable mortality (4.7% vs. 4.8%; P-value=0.93) Conclusions Toxin-positive patients were more likely to have severe/complicated forms of CDI and recurrences. Nevertheless, CDI-related complications may still occasionally occur among toxin-negative patients diagnosed by PCR, thus stressing the need for individualized clinical evaluation.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304317

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