Real-time polymerase chain reaction (PCR) cycle threshold and Clostridioides difficile infection outcomes

Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence,...

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Published in:Infection control and hospital epidemiology Vol. 42; no. 10; pp. 1228 - 1234
Main Authors: Choi, Byungwoo, Wong, Ken Koon, Dunn, Aaron N., Butler, Robert, Fraser, Thomas G., Procop, Gary W., Richter, Sandra S., Isada, Carlos M., Deshpande, Abhishek
Format: Journal Article
Language:English
Published: United States Cambridge University Press 01.10.2021
Subjects:
Age
Antibiotics
Comorbidity
Creatinine
Data collection
Demographics
Health facilities
Hospitals
Hypotension
Infections
Infectious diseases
Laboratories
Length of stay
Mortality
Patients
Polymerase chain reaction
Variables
Variance analysis
ISSN:0899-823X, 1559-6834, 1559-6834
Online Access:Get full text
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Summary:Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI. Retrospective cohort study. Single tertiary-care hospital. Adult patients diagnosed with hospital-onset, healthcare facility-associated CDI from June 2014 to September 2015. We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality. Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe-complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23-40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72-0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90-1.09) or recurrence (OR, 0.88; 95% CI, 0.77-1.00). Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.
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ISSN:0899-823X
1559-6834
1559-6834
DOI:10.1017/ice.2020.1405