A Clostridium difficile infection “intervention”: Change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes - 28/04/12
, Kathleen M. McMullen, MPH, CIC b, Anthony J. Russo, MPH b, Susan M. Copper, MT(ASCP) b, David K. Warren, MD, MPH a, Erik R. Dubberke, MD, MSPH a
Address correspondence to Zhuolin Han, MD, MS, Division of Infectious Diseases, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8051, St Louis, MO 63110-1093.Abstract |
Background |
Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes.
Methods |
Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change).
Results |
Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01).
Conclusions |
The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.
Le texte complet de cet article est disponible en PDF.Key Words : Toxin enzyme immunoassay, Metronidazole, Vancomycin
Plan
| This work was supported by the Centers for Disease Control and Prevention (Grant 5U01C1000333) and National Institute of Allergy and Infectious Diseases (Grant K23AI065806). |
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| Conflict of interest: Erik R. Dubberke has performed research for Optimer and Merck and has served as a consultant for Optimer, Merck, and Pfizer. The other authors have no conflicts of interest to disclose. |
Vol 40 - N° 4
P. 349-353 - mai 2012 Retour au numéro
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