Clinical Microbiology and Infection
Clinical Microbiology and Infection
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

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.