2361. Evaluation of a 2-Step Testing Algorithm for Clostridioides difficile Infection

Background Clinical data describing use of a multistep algorithm for diagnosis of Clostridioides difficile infection (CDI) is limited. In June 2018 we implemented a 2-step testing algorithm in which PCR testing (Aries® assay) is performed for all specimens followed by EIA toxin testing (TOX A/B QUIK...

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Published in:Open forum infectious diseases Vol. 6; no. Supplement_2; p. S813
Main Authors: Zuccaro, Patricia, Son, Andrea, Conti, Jennifer, Hecker, Michelle
Format: Journal Article
Language:English
Published: Oxford Oxford University Press 23.10.2019
Subjects:
Abstracts
Algorithms
ISSN:2328-8957, 2328-8957
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Abstract Background Clinical data describing use of a multistep algorithm for diagnosis of Clostridioides difficile infection (CDI) is limited. In June 2018 we implemented a 2-step testing algorithm in which PCR testing (Aries® assay) is performed for all specimens followed by EIA toxin testing (TOX A/B QUIK CHEK® assay) when PCR is positive. We sought to describe outcomes for patients with PCR+/EIA+ vs. PCR+/EIA− results. Outcomes evaluated included frequency of CDI treatment, retesting and retreatment within 3 months, and investigator determined categorization of C. difficile results by an investigator blinded to the EIA result. Methods A retrospective cohort study was performed on a random sample of 85 unique patients with a PCR+ stool sample from July 2018 through December 2018. Demographic and clinical data were abstracted from the medical record during the index encounter and for 3 months thereafter. Based on predetermined criteria, index encounter results were categorized as representing probable, possible, unlikely, or indeterminate cases of symptomatic CDI. Results For the 85 study patients, 42%, 27%, and 31% were tested in the inpatient, outpatient, and ED/urgent care settings. Twenty-seven patients (32%) were EIA+, all of whom received CDI treatment. Fifty-eight (68%) were EIA-, of which 79% received treatment. Of the 12 EIA- patient who did not receive treatment two had retesting within 3 months; one of whom subsequently tested EIA+ and was treated and the other tested PCR-. At least 1 C. difficile test was repeated within 3 months in 48% of EIA+ and 33% of EIA- patients. Based on repeat testing CDI treatment was prescribed for 12% of EIA+ subjects and for 11% of EIA- subjects. For the EIA+ patients, 70%, 19%, 7%, and 4% were classified as probable, possible, unlikely and indeterminate cases of symptomatic CDI when compared with 38%, 34%, 22%, and 5% for EIA- patients. Conclusion During the first 6 months of a 2-step testing algorithm, we found that patients with EIA- test results were frequently treated for CDI and that 72% of EIA- cases were classified as probably or possibly having symptomatic CDI. Further study is needed to determine whether patients with EIA- results categorized with probable or possible symptomatic CDI would improve without CDI treatment. Disclosures All authors: No reported disclosures.
AbstractList Background Clinical data describing use of a multistep algorithm for diagnosis of Clostridioides difficile infection (CDI) is limited. In June 2018 we implemented a 2-step testing algorithm in which PCR testing (Aries® assay) is performed for all specimens followed by EIA toxin testing (TOX A/B QUIK CHEK® assay) when PCR is positive. We sought to describe outcomes for patients with PCR+/EIA+ vs. PCR+/EIA− results. Outcomes evaluated included frequency of CDI treatment, retesting and retreatment within 3 months, and investigator determined categorization of C. difficile results by an investigator blinded to the EIA result. Methods A retrospective cohort study was performed on a random sample of 85 unique patients with a PCR+ stool sample from July 2018 through December 2018. Demographic and clinical data were abstracted from the medical record during the index encounter and for 3 months thereafter. Based on predetermined criteria, index encounter results were categorized as representing probable, possible, unlikely, or indeterminate cases of symptomatic CDI. Results For the 85 study patients, 42%, 27%, and 31% were tested in the inpatient, outpatient, and ED/urgent care settings. Twenty-seven patients (32%) were EIA+, all of whom received CDI treatment. Fifty-eight (68%) were EIA-, of which 79% received treatment. Of the 12 EIA- patient who did not receive treatment two had retesting within 3 months; one of whom subsequently tested EIA+ and was treated and the other tested PCR-. At least 1 C. difficile test was repeated within 3 months in 48% of EIA+ and 33% of EIA- patients. Based on repeat testing CDI treatment was prescribed for 12% of EIA+ subjects and for 11% of EIA- subjects. For the EIA+ patients, 70%, 19%, 7%, and 4% were classified as probable, possible, unlikely and indeterminate cases of symptomatic CDI when compared with 38%, 34%, 22%, and 5% for EIA- patients. Conclusion During the first 6 months of a 2-step testing algorithm, we found that patients with EIA- test results were frequently treated for CDI and that 72% of EIA- cases were classified as probably or possibly having symptomatic CDI. Further study is needed to determine whether patients with EIA- results categorized with probable or possible symptomatic CDI would improve without CDI treatment. Disclosures All authors: No reported disclosures.
Author Hecker, Michelle
Son, Andrea
Zuccaro, Patricia
Conti, Jennifer
AuthorAffiliation MetroHealth Medical Center , Cleveland, Ohio
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Copyright The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2019
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– notice: The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2019
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Snippet Background Clinical data describing use of a multistep algorithm for diagnosis of Clostridioides difficile infection (CDI) is limited. In June 2018 we...
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Title 2361. Evaluation of a 2-Step Testing Algorithm for Clostridioides difficile Infection
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