Diagnostic stewardship of Clostridioides difficile polymerase chain reaction results from syndromic diarrhea panel and implications for patient outcomes

Francis Wadskier, Kelsie Cowman, Wendy A. Szymczak, Greg Weston, Yi Guo, Rachel Bartash, Michael H. Levi, Priya Nori

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A syndromic gastrointestinal pathogen panel (GIP) was implemented in May 2018. All positive (+) GIP and standard-of-care (SOC) C. difficile results were reviewed. Methods: A single-center audit of adult patients with GIP results was conducted May–December 2018. We reviewed GIP(+)/SOC(+/-) and GIP(-)/SOC(-) tests (control group) for clinical outcomes. Results: We reviewed 269 GIP(+) patients. Of 119 GIP(+)/SOC(+) patients, 44 (37%) were positive by toxin A/B enzyme immunoassay, and 75 (63%) by PCR only. Thirty-day mortality and re-admission were not significantly different between groups. CDI rates within 6 months were not significantly different between GIP(+)/SOC(-) and controls (p-value = 0.39). Those with initial SOC(+) tests had more true CDI events within 6 months, compared to controls (p-values < 0.001). Conclusions: Forty percent of patients with GIP(+) C. difficile were (-) by SOC test, suggesting that true CDI was not present. Additional PCR-based testing may not impact outcomes.

Original languageEnglish (US)
Article number115032
JournalDiagnostic Microbiology and Infectious Disease
Volume97
Issue number2
DOIs
StatePublished - Jun 2020

Keywords

  • Clostridiodes difficile infection
  • diagnostic stewardship
  • gastrointestinal pathogen panel

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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