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Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.

Publication ,  Journal Article
Turner, NA; Krishnan, J; Nelson, A; Polage, CR; Cochran, RL; Fike, L; Kuhar, DT; Kutty, PK; Snyder, RL; Anderson, DJ
Published in: Clin Infect Dis
October 5, 2023

BACKGROUND: Two-step testing for Clostridioides difficile infection (CDI) aims to improve diagnostic specificity but may also influence reported epidemiology and patterns of treatment. Some providers fear that 2-step testing may result in adverse outcomes if C. difficile is underdiagnosed. METHODS: Our primary objective was to assess the impact of 2-step testing on reported incidence of hospital-onset CDI (HO-CDI). As secondary objectives, we assessed the impact of 2-step testing on C. difficile-specific antibiotic use and colectomy rates as proxies for harm from underdiagnosis or delayed treatment. This longitudinal cohort study included 2 657 324 patient-days across 8 regional hospitals from July 2017 through March 2022. Impact of 2-step testing was assessed by time series analysis with generalized estimating equation regression models. RESULTS: Two-step testing was associated with a level decrease in HO-CDI incidence (incidence rate ratio, 0.53 [95% confidence interval {CI}, .48-.60]; P < .001), a similar level decrease in utilization rates for oral vancomycin and fidaxomicin (utilization rate ratio, 0.63 [95% CI, .58-.70]; P < .001), and no significant level (rate ratio, 1.16 [95% CI, .93-1.43]; P = .18) or trend (rate ratio, 0.85 [95% CI, .52-1.39]; P = .51) change in emergent colectomy rates. CONCLUSIONS: Two-step testing is associated with decreased reported incidence of HO-CDI, likely by improving diagnostic specificity. The parallel decrease in C. difficile-specific antibiotic use offers indirect reassurance against underdiagnosis of C. difficile infections still requiring treatment by clinician assessment. Similarly, the absence of any significant change in colectomy rates offers indirect reassurance against any rise in fulminant C. difficile requiring surgical management.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

October 5, 2023

Volume

77

Issue

7

Start / End Page

1043 / 1049

Location

United States

Related Subject Headings

  • Microbiology
  • Longitudinal Studies
  • Humans
  • Delivery of Health Care
  • Clostridium Infections
  • Clostridioides difficile
  • Clostridioides
  • Anti-Bacterial Agents
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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MLA
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Turner, N. A., Krishnan, J., Nelson, A., Polage, C. R., Cochran, R. L., Fike, L., … Anderson, D. J. (2023). Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level. Clin Infect Dis, 77(7), 1043–1049. https://doi.org/10.1093/cid/ciad334
Turner, Nicholas A., Jay Krishnan, Alicia Nelson, Christopher R. Polage, Ronda L. Cochran, Lucy Fike, David T. Kuhar, Preeta K. Kutty, Rachel L. Snyder, and Deverick J. Anderson. “Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.Clin Infect Dis 77, no. 7 (October 5, 2023): 1043–49. https://doi.org/10.1093/cid/ciad334.
Turner NA, Krishnan J, Nelson A, Polage CR, Cochran RL, Fike L, et al. Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level. Clin Infect Dis. 2023 Oct 5;77(7):1043–9.
Turner, Nicholas A., et al. “Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.Clin Infect Dis, vol. 77, no. 7, Oct. 2023, pp. 1043–49. Pubmed, doi:10.1093/cid/ciad334.
Turner NA, Krishnan J, Nelson A, Polage CR, Cochran RL, Fike L, Kuhar DT, Kutty PK, Snyder RL, Anderson DJ. Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level. Clin Infect Dis. 2023 Oct 5;77(7):1043–1049.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

October 5, 2023

Volume

77

Issue

7

Start / End Page

1043 / 1049

Location

United States

Related Subject Headings

  • Microbiology
  • Longitudinal Studies
  • Humans
  • Delivery of Health Care
  • Clostridium Infections
  • Clostridioides difficile
  • Clostridioides
  • Anti-Bacterial Agents
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences