The Impact of Switching to Two-Step Testing on Reducing Rates of Hospital Acquired Clostridioides Difficile Infection
Background
Clostridioides difficile infection (CDI) diagnosis is challenging. Positive polymerase chain reaction (PCR) in colonized patients can impact hospital-acquired CDI (HACDI) rates. A negative toxin A/B enzyme immunoassay (EIA) as a second step can help determine colonization.
Objective
We aimed to study the impact of a two-step testing on HACDI rates and treatment.
Methods
Two-step testing consisted of positive PCR followed by EIA. Patients with positive PCR / negative EIA were retrospectively included and further classified based on treatment.
Results
Ninety-six patients were included and. Sixty-five (68%) were treated. HACDI was avoided in 18 cases (18.8%). There were more HACDI avoided in the non-treated compared to the treated group (32.3% vs 12.3%; p=0.026). Most non-treated patients were tested on medical-surgical units (77.4%), 49.2 % of the treated patients were tested in emergency or intensive care units. Treated patients were more likely to have leukocytosis and / or fever (66.2%) compared to non-treated patients (29%; p= 0.0009). There was no difference in abdominal pain, diarrhea, or constipation.
Most patients had an abdominal CT (70.8%), of which colitis was found in 48.5%. Treated patients were more likely to have colitis on CT vs non-treated patients (43.1% vs 16.1%; p<0.011).
Compared to non-treated patients, treatment did not affect home disposition or 30-day readmission rates (80% vs 71%, P=0.436) and (25 % vs 29%, P= 0.63) respectively.
Discussion
Two-step testing led to decreased HACDI rates without affecting discharge disposition or readmission rates in patients with PCR positive / EIA negative results regardless of treatment.
Keywords: Two-step testing, Clostridioides difficile, Hospital- Acquired
