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Impact of molecular testing on reported Clostridoides difficile infection rates.

Publication ,  Journal Article
Ilieş, I; Benneyan, JC; Jabur, TBC; Baker, AW; Anderson, DJ
Published in: Infect Control Hosp Epidemiol
March 2020

BACKGROUND: The reported incidence of Clostridoides difficile infection (CDI) has increased in recent years, partly due to broadening adoption of nucleic acid amplification tests (NAATs) replacing enzyme immunoassay (EIA) methods. Our aim was to quantify the impact of this switch on reported CDI rates using a large, multihospital, empirical dataset. METHODS: We analyzed 9 years of retrospective CDI data (2009-2017) from 47 hospitals in the southeastern United States; 37 hospitals switched to NAAT during this period, including 24 with sufficient pre- and post-switch data for statistical analyses. Poisson regression was used to quantify the NAAT-over-EIA incidence rate ratio (IRR) at hospital and network levels while controlling for longitudinal trends, the proportion of intensive care unit patient days, changes in surveillance methodology, and previously detected infection cluster periods. We additionally used change-point detection methods to identify shifts in the mean and/or slope of hospital-level CDI rates, and we compared results to recorded switch dates. RESULTS: For hospitals that transitioned to NAAT, average unadjusted CDI rates increased substantially after the test switch from 10.9 to 23.9 per 10,000 patient days. Individual hospital IRRs ranged from 0.75 to 5.47, with a network-wide IRR of 1.75 (95% confidence interval, 1.62-1.89). Reported CDI rates significantly changed 1.6 months on average after switching to NAAT testing (standard deviation, 1.9 months). CONCLUSION: Hospitals that switched from EIA to NAAT testing experienced an average postswitch increase of 75% in reported CDI rates after adjusting for other factors, and this increase was often gradual or delayed.

Duke Scholars

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Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

March 2020

Volume

41

Issue

3

Start / End Page

306 / 312

Location

United States

Related Subject Headings

  • Southeastern United States
  • Sentinel Surveillance
  • Nucleic Acid Amplification Techniques
  • Molecular Diagnostic Techniques
  • Immunoenzyme Techniques
  • Humans
  • Hospitals
  • Epidemiology
  • Clostridium Infections
  • Clostridioides difficile
 

Citation

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Ilieş, I., Benneyan, J. C., Jabur, T. B. C., Baker, A. W., & Anderson, D. J. (2020). Impact of molecular testing on reported Clostridoides difficile infection rates. Infect Control Hosp Epidemiol, 41(3), 306–312. https://doi.org/10.1017/ice.2019.327
Ilieş, Iulian, James C. Benneyan, Tiago Barbieri Couto Jabur, Arthur W. Baker, and Deverick J. Anderson. “Impact of molecular testing on reported Clostridoides difficile infection rates.Infect Control Hosp Epidemiol 41, no. 3 (March 2020): 306–12. https://doi.org/10.1017/ice.2019.327.
Ilieş I, Benneyan JC, Jabur TBC, Baker AW, Anderson DJ. Impact of molecular testing on reported Clostridoides difficile infection rates. Infect Control Hosp Epidemiol. 2020 Mar;41(3):306–12.
Ilieş, Iulian, et al. “Impact of molecular testing on reported Clostridoides difficile infection rates.Infect Control Hosp Epidemiol, vol. 41, no. 3, Mar. 2020, pp. 306–12. Pubmed, doi:10.1017/ice.2019.327.
Ilieş I, Benneyan JC, Jabur TBC, Baker AW, Anderson DJ. Impact of molecular testing on reported Clostridoides difficile infection rates. Infect Control Hosp Epidemiol. 2020 Mar;41(3):306–312.
Journal cover image

Published In

Infect Control Hosp Epidemiol

DOI

EISSN

1559-6834

Publication Date

March 2020

Volume

41

Issue

3

Start / End Page

306 / 312

Location

United States

Related Subject Headings

  • Southeastern United States
  • Sentinel Surveillance
  • Nucleic Acid Amplification Techniques
  • Molecular Diagnostic Techniques
  • Immunoenzyme Techniques
  • Humans
  • Hospitals
  • Epidemiology
  • Clostridium Infections
  • Clostridioides difficile