Overreporting healthcare-associated C. difficile: A comparison of NHSN LabID with clinical surveillance definitions in the era of molecular testing - 31/08/18
, Barbara Ross, RN, MS, CIC, FAPIC a, David P. Calfee, MD, MS a, b, Matthew S. Simon, MD, MS a, bHighlights |
• | Healthcare facility-onset C. difficile infections may be overreported. |
• | Laxative and stool softener use contribute to overinflated rates of C. difficile. |
• | Inappropriate testing for C. difficile may lead to unnecessary treatment. |
Abstract |
Background |
Clostridium difficile infection (CDI) is the most common healthcare-associated gastrointestinal infection. Hospitals are required to report cases of healthcare facility-onset CDI (HO-CDI) using the National Healthcare Safety Network's CDI laboratory-identified (LabID) event definition. The aim of this study was to determine the extent of potential over-reporting due to the exclusion of important clinical data within LabID reporting definitions.
Methods |
In 2015, retrospective chart review was performed on 212 HO-CDI cases reported from a large urban medical center. Cases had positive polymerase chain reaction test for the C. difficile toxin B gene from an unformed stool specimen collected >3 days after admission and >8 weeks after most recent LabID event. Cases were categorized into “clinical surveillance” groups: community-acquired infection, recurrence/relapse, asymptomatic colonization, colonization with self-limited symptoms, possible HO-CDI, and probable HO-CDI.
Results |
Of the infections, 13.6% were community acquired, 2.8% were recurrent/relapse, 1.9% were asymptomatic colonization, 18.4% were symptomatic colonization, 38.7% were possible HO-CDI, and 24.5% were probable HO-CDI. Within 24 hours of testing, 34.1% of patients had received a stool softener and/or laxative.
Conclusions |
Laxative use and failure to identify community-onset infection may contribute to misclassification of HO-CDI. Only 62% of reported cases met clinical surveillance criteria.
Le texte complet de cet article est disponible en PDF.Key Words : Clostridium difficile, Healthcare-associated infections, Surveillance, Infection control, Public reporting
Plan
| Conflicts of interest: None to report. |
Vol 46 - N° 9
P. 998-1002 - septembre 2018 Retour au numéro
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